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 Form
Alternative 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.
These slides are provided as an example of disclosure slides to be used all learning activities or sessions presented at Conferences.
Expert Review
Two options are available to providers in conducting expert review. Please choose the form based on your selected option. Further details on the options are found in Guideline A, the links to which are provided below.
The following form is to be completed by the two external expert reviewers, where Option 1 for Expert Review is selected under Guideline A:
The following form is to be completed by members of the Expert Panelm where Option 2 for Expert Review is selected, under Guideline A: Expert Review Options:
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 selecting the alternative review option review process. Refer to Guideline I: Alternate Review Option for Larger Learning Activities or Multiple Accreditations for additional information on this option.
As noted Guideline I, this option is only considered by CCCEP when:
- The Learning activity is a large activity (usually 10 CEUs or greater), or
- The program provider is also submitting the learning activity to be accredited by another accreditation agency.
If approval is granted by CCCEP for the use of the Alternate Review Process, the following form is to be used for the Alternative Review.
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
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.
