Required Forms
IMPORTANT NOTE: These forms are updated periodically. If you have downloaded forms previously, please check the website to ensure you have the most current form.
The following forms are used with your application for CCCEP accreditation:
The required forms may be found by scrolling down the page, or clicking on one of the following links.
Disclosure/COI Forms and Slide Templates
Alternate Review Form
Learning Objective Mapped Forms
Disclosure
The Statement of Disclosure is to be completed by all authors, presenters, moderators, expert reviewers, and planning committee members.
For conference applications, one disclosure form for each author/presenter is sufficient, even if they are presenting multiple sessions.
- Sample disclosure slides are provided to assist providers, speakers/presenters in ensuring CCCEP's disclosure requirements are met.
- Personal Disclosure Slide Template (for presenters and speakers)
- Commercial Disclosure Slide Template
Expert Review
The following form is to be completed by two external expert reviewers, in accordance with Guideline A:
Declaration Form
This form is to be completed by the provider's representative. Conference organizers must also complete this form.
Accreditation Checklist
Completed checklists must be submitted with every new learning activity or conference application. It will also assist you in compiling the required documents and forms that must be submitted with your application for CCCEP accreditation. A separate checklist is available for Conference Accreditation Submissions. Please ensure you download and complete the appropriate checklist.
- Accreditation Checklist
- Conference Accreditation Checklist
- Regularly Scheduled Series Accreditation Checklist and Provider Declaration
Translation Form
The following form is used only if you are submitting a program that has been translated from French to English or English to French.
Alternate Review Form
The Program Provider must obtain approval from CCCEP to use the Alternate Review Process prior to submitting their program to CCCEP for accreditation. Refer to Guideline A: Expert Review and Panel Review for additional information on this option.
Approval for using this alternate review process can be requested by email to cccep@cccep.ca.
If approval is granted by CCCEP for the use of the Alternate Review Process, the alternate review form, which is to be completed by the Panel, will be provided to you directly from CCCEP.
Mergener Formula
Competency Mapped Accreditation Forms
IMPORTANT NOTE: The forms below pertain to the Stage 2 review process for Competency Mapped Accreditation and should not be submitted until your Stage 1 review has been completed. Information on the application process for competency mapped accreditation can be found here.
- Immunization and Injections Stage 2 Application Form - for Pharmacists
- Immunization and Injections Stage 2 Application Form - for Pharmacy Technicians
- Cannabis and Patient Care in Pharmacy Stage 2 Application Form
- Non-sterile Compounding Stage 2 Application Form
- Sterile Non-hazardous Compounding Stage 2 Application Form
- Sterile Hazardous Compounding Stage 2 Application Form
Learning Objective Mapped Accreditation Forms
IMPORTANT NOTE: The form below pertains to the Stage 2 review process for Learning Objective Mapped Accreditation and should not be submitted until your Stage 1 review has been completed. Information on the application process for learning objective mapped accreditation can be found here.
