CSHP Chapter Accreditation Services

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CSHP is pleased to provide ACPE accreditation services to our affiliate chapters.

Prior to the Event

Complete the chapter accreditation request form below no less than 6 weeks prior to your event. Activity announcements/flyers should be sent out or posted 30 days prior to an event and must have complete ACPE accreditation information included.

During the Event

Check membership of attendees as they enter. If an attendee is not a current CSHP member and they would like to claim CPE credit for the event, the charge is $25 for events 2 hours or less. Attendees may use the Membership Application form to pay or go to the online store at CSHP Online Store.

Be sure to announce the session code and review the directions for claiming credit at the end of the session.

CE Accreditation Request Form

For Affiliate Chapter Use Only

Affiliate Chapter Contact Information

Affiliate Chapter *
First Name *		Last Name *
Phone Area Code *		Phone *
Email Address *
Proposed Course Information

Course Title *
Anticipated Date of Program *Please write in date format MM/DD/YYYY
Presentation Location (Including City) *		Presentation Length *
Target Audience *Please check all that apply	Pharmacists Pharmacy Technicians Nurses
Not sure if your learning objectives are ACPE compliant? Take a peek at the tips below!
Tips for Writing Learning Objectives
Learning Objectives *Please list separate objectives for pharmacists and pharmacy technicians. Course without proposed learning objectives will not be considered.
Brief Course Description *Please describe your proposed course including how it addresses an educational need, the overall purpose of the course, and any special requirements your course will have.
Level of Educational ContentLevel of Educational Content	Level 1 - No Prior Knowledge Level 2 - Working Knowledge Level 3 - Advanced Knowledge
Submission Category	Knowledge-based: Primarily for participants to acquire factual knowledge Application-based: Primarily for participants to apply the info learned in the allotted timeframe
Do you have a funding source or can you identify grant opportunities for your subject matter? *
Please complete and upload your draft CE event flyer if possible. A sample version is provided below
Sample CE Flyer
Upload Draft Event Flyer
Proposed Speaker(s) Information

Please complete the attached speaker disclosure form and upload the completed and signed form here:
Speaker Disclosure Form Download
Upload Speaker 1 Disclosure Form *
Upload Speaker 2 Disclosure Form
Proposed Speaker(s) *Who will be presenting this program? Please include all speakers, their credentials and their employer.
Upload Resume or CV *
Upload Resume or CV:If you would like to upload more than two files, please contact Cindy Bouris at cbouris@cshp.org.
Upload Final Event Flyer (includes all ACPE information provided by CSHP)
Upload Presentation File (PPT, PDF, etc.)
Additional Information and Agreement *	Yes, I agree to the statement below: By checking this box, you agree to adhere to both ACPE standard

Contacts

California Society of Health-System Pharmacists
1314 H Street, Suite 200
Sacramento, CA 95814
Office: (916) 447-1033
Fax: (916) 447-2396
Email: info@cshp.org
Hours: M-F 8:00am – 5:00pm