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
Declaration Form
Alternative Review Form
Learning Objective Mapped Forms
Disclosure
- Statement of Disclosure/Conflict of Interest
The Statement of Disclosure is to be completed by all individuals (authors, presenters, expert reviewers, provider representatives, conference organizer representatives etc.) involved in the development and delivery of a learning activity. For conference applications one disclousre form for each author/presenter is sufficicient, even if they are presenting multiple sessions. However, a declaration form (see section below) is required from the author/presenter for each session they are presenting.
These slides are provided as an example of disclosure slides to be used in a Live or Blended learning activity and for sessions presented at Conferences.
Expert Review
The following form is used for all expert reviews, except for those using Option 2 (expert panel) for the expert review (see link to Guideline A below for information on Option 2).
The following form is used only when the the Expert Panel Option (Option 2) is chosen, in accordance with Guideline A: Expert Review Options.
Declaration Form
- Declaration Form
This form is to be completed by the provider's representative, author(s) of the learning activity and presenter(s) of learning activities, including authors and presenters of conference sessions. Conference organizers must also complete this form. Presenters at conferences must complete this form for each session they are presenting.
Accreditation Checklist
The following form must be submitted with every new learning activity 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
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 prior to selecting the alternative review option review process. As noted in the Guideline, 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.
Refer to Guideline I: Alternate Review Option for Larger Learning Activities or Multiple Accreditations for additional information on this option.
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.
