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Recommended if applying to Liberia National Physician Assistants Association & Board

CPD Course Approval Form

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CPD providers must complete and submit this form for a course to be approved as Category A (accredited CPD course) content and assigned Continuing Education Units (CEUs) that count towards licensure requirements. Before completing this form, ensure that your organization is registered as a CPD provider.

Name of CPD Provider

Contact Person

Job Title of Contact Person

Phone Number of Contact Person

Email Address of Contact Person

Physical Address of Contact Person

Website

Current CPD Provider Registration Expiration Date

For each Facilitator, complete the below cell (1 sentence for each facilitator) and attach their CV

Submit the below documents by email:

Facilitator CV
Facilitator CV
Facilitator CV

Course Title

Describe how participants will sign-up or be selected. For CPD courses targeting specific individuals, explain how those individuals are prioritized.

How long is the course? If occurring over multiple days or months, describe how the hours will be divided up.

Proposed CEUs for Course: 1 hour = 0.1 CEUs

* Select the proposed course format. If hybrid, provide additional details of the breakdown.

In-person training

Online

Hybrid (explain):

In 1-3 sentences, describe the need for this course. What health challenge is being addressed? What best practices will be taught? What evidence informs the proposed content?

By the end of the proposed CPD course, participants will be able to. . .

For CPD courses that are more than 4 hours long, a session plan is required. You may add additional rows to the template below if needed.

What requirements must participants fulfill to successfully complete the course? This may include some combination of attendance, completion of assignments, and achievement of a certain score on assessments (e.g. post-test, skills observation such as an OSCE).

Describe how the course will be evaluated to inform ongoing improvement in CPD content and delivery. This may include post-course surveys by participants, an after-action review, etc.

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