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CMLE Program Approval Form

Please provide the following information about the CMLE activity:
	Program Title:
	Program Date:
	Total Credits Requested:
	Sponsoring Organization:
	Contact Person:
*	Billing Address:
	Billing Address 1:
*	City:
*	State:
*	Zip Code:
	Email Address:
	Phone Number:
Effective November 7, 2008, there will be a $15.00 fee per credit hour, for which you will be invoiced upon approval. Please upload the following information:
Please include the following in your Preliminary Program: - date and time of each activity - list of program faculty (including title, qualifications and disclosure information.) - educational objectives (measurable and clearly stated to participants.)
	Preliminary Program:
	Example of evaluation form used:
-OR-
	Description of evaluation mechanism:
	Sample of participants certificate:
The information must be submitted on line 60 days prior to the program event
You will receive a course number, once your course is approved. This is the number to include on the participant certificate. It is not necessary to send sign-in sheets after the course.
To obtain information about the status of your request, contact Jodi Smith, Educational Programs Coordinator at (302) 543-6583.