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Education Activity Application

The Canadian Dermatology Association entertains proposals for new education activities throughout the year. To submit a proposal for consideration, please complete and submit this application form. All applications are considered based on merit, current interest and assessed needs. If you have any questions about the application process, please email education@dermatology.ca.
Contact Information
1.Company name(Required.)
2.Contact person and title(Required.)
3.Contact email(Required.)
4.Contact phone number(Required.)
Activity Details
5.Proposed activity title(Required.)
6.Activity summary
Provide a one-paragraph description highlighting the learning goal(s) and/or purpose of the activity. (Required.)
7.Activity type and frequency(Required.)
8.Accreditation to be provided(Required.)
9.When is the activity to be offered? Please allow at least 6 months for planning and marketing(Required.)
Detailed Activity Description
10.What content and/or quality improvement will be addressed by the activity?(Required.)
11.Why is this activity necessary?
Please include needs assessment data and/or references to support your answer(Required.)
12.For any data that cannot be included in Question 8, please upload here
No file chosen
13.Proposed learning objectives
Learning objectives must be written from the learner's perspective. For helpful tips, see How to Create Learning Objectives and How to write well-defined learning objectives. Please avoid unmeasurable or interpretive verbs such as "learn", "appreciate" and "understand".

At the end of this activity, participants will be able to(Required.)
14.Applicable CanMEDS Roles
Identify three or more CanMEDS Roles the activity will touch on.(Required.)
15.SMART objectives (specific, measurable, achievable, relevant, time-bound)
Answer two or more of the following(Required.)
16.Proposed faculty and role
Identify content experts and/or the expertise needed to develop the activity. All faculty will be subject to approval by the CDA.(Required.)
17.Proposed format:
Include any requirements needed to deliver this activity, including tools and equipment for interactivity. An agenda may be provided.
(Required.)
18.Medical communications company services:(Required.)
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