ACCREDITATION APPLICATION FOR CNSW CE ACTIVITIES The following provides a step-by-step overview of how to submit your Local Chapter's activity for accreditation through the NKF National Headquarters office for Social Worker activities to be accredited through ASWB, and the documentation that will need to be prepared and submitted. Please fill out all of the forms below and submit them when they are completed in their entirety. Submissions that are sent without all required parts will not be considered for accreditation. Process overview: Creates sign-in sheet for attendees (this will need to be scanned and submitted after the meeting) Sample is included. Print out certificates to be distributed Print out evaluations to be distributed and collected Makes sure sign-in sheet lists all attendees Distributes and collects session evaluations Distributes certificates to participants Compiles evaluations into a summary and returns participant forms and summary to NKF Scans/returns electronically the sign-in sheet(s) to NKF Are you ready to submit your activity for National Office approval? Email this completed packet to with all your additional materials (speakers CVs, marketing materials, etc).
EDUCATIONAL PLANNING TABLE Activity Title: Activity Date: Educational Planning Table Objectives Content (Outline of Topics) Timeframe Faculty Teaching Methods Identify what the learner will know or be able to do following participation in the CE activity (2-3 per hour of content) Provide an outline of the topics that will be covered that correspond with each learning objective. State the timeframe for each learning objective List the Faculty for each learning objective Describe the teaching methods, strategies, materials & resources used for each learning objective Session Title Session Title Session Title
1 1 1 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 III. Overall Activity Evaluation: Course material was appropriate to my education, experience and/or licensure level 5 4 3 2 1 Course material was relevant to my professional needs/scope of practice 5 4 3 2 1 Course material was current 5 4 3 2 1 The course materials presented the course content effectively 5 4 3 2 1 Handouts and teaching aids enhanced the content of the course 5 4 3 2 1 The location of this activity was suitable 5 4 3 2 1 The facilities were conducive to learning 5 4 3 2 1 The instructions for requesting accommodations for a disability were clear 5 4 3 2 1 Program administration questions or concerns were addressed effectively and in a timely manner 5 4 3 2 1 I plan to make changes in my practice based on the information in this activity Yes, planned changes include: (Check all that apply): Modify my approach to referral or co-management Modify my patient education information/materials Modify elements of staff training or treatment protocols in my practice Other: ____________________________________________________________ No. Please explain _________________________________________________________ What is your level of commitment to making the changes stated above? Very committed Somewhat committee Not very committed Do not expect to change I would recommend this activity to my peers 5 4 3 2 1 How did you learn about this activity? Brochure E-mail Professional Journal NKF Web site Co-Worker Direct Mail Don’t Recall Other_________