RESNA-CEU CO-SPONSORSHIP APPLICATION Please submit a complete application for every training. The information allows RESNA to evaluate continuing education courses to determine whether the training provider may award RESNA Continuing Education Units (CEUS) to individuals who complete the training. Name of sponsoring organization: Street address: City/State/Zip: Website address: Type of Organization (choose one):! Academic institution! Government or Military! Insurance Company/HMO! School District! Association! Health Care Delivery System! Products/Supply Company! Other:! Education Company! Hospital! Publishing Company Name of Continuing Education Coordinator: Phone number: Email: Payment Payment of the training evaluation fee is due in full with the application. If RESNA finds that your organization has not satisfactorily fulfilled the criteria for RESNA-CEU sponsorship of the training(s), you will be contacted for additional documentation. If you elect to rescind your application for sponsorship, then RESNA will refund 50% of your payment; the remaining payment will be retained as a processing fee. Training evaluation fee (check one box below): Single, one-time training session.! RESNA member: $75! Non-RESNA member: $150 If your organization plans to offer more than three training concurrent sessions, then please contact RESNA at 703-524-6686, ext 316, or certification@resna.org to inquire about package pricing. Single, repeating training session (e.g. self-study online). Note: Repeating sessions will incur an additional per-head fee of $16 per attendee. This per-head fee will be invoiced to you upon RESNA s receipt of your attendee spreadsheet.! RESNA member: $75! Non-RESNA member: $150 Conference training sessions (discounted rate for multiple sessions delivered on same and/or adjacent days):! RESNA member: $60 per course X Number of sessions: = $ ($1000 maximum)! Non-RESNA member: $125 per course X Number of sessions: = $ ($1500 maximum) Conference name: Conference location: Conference dates: Organization sponsoring conference: Payment method:! MasterCard! Visa! Check! Purchase Order Credit card Number: Expiration Date: 3-digit security code: Name on card: Billing address: Signature: Mail this application with payment to: RESNA-CEU Sponsorship, 1700 N. Moore St, Suite 1540, Arlington VA 22209. If paying by credit card, email it to certification@resna.org.
Evaluation of Training for RESNA-CEUs Please submit a complete form for each training session for which you are requesting RESNA-CEUs. Course information Training title: Length (in hours): Location (city/state or online ): Date: If you would like to list this course on the RESNA website, provide the link: Who will issue the RESNA-CEU documentation?! Sponsoring organization! RESNA How will you submit attendance information to RESNA?! We will be providing CEUs for all attendees and submit spreadsheet to RESNA! Attendees will individually submit requests for CEUs to RESNA. Our organization will provide the attendees with an application form for individual RESNA-CEUs. (A template Application for Individual RESNA-CEUs is in this package.) Instructor Information Instructor/speaker #1: Instructor/speaker #2: Instructor/speaker #3: For each training instructor, attach both of the following: a bio or CV which indicates the person's qualifications to instruct the training session; and signed Speaker Agreement form (found on the following page) Criteria for RESNA-CEU Co-Sponsorship In addition to the speaker bio(s) and signed Speaker agreement, you must submit a write-up which explains how you have satisfied each of the following criteria for RESNA-CEU co-sponsorship. The write-up must include: Needs Assessment Planned Training Goal and Instructional Objectives Training Session Description Teaching Methods and Time Allocation (For courses more than four hours in length, complete the Teaching Methods and Time Allocation Table instead.) Assessment of Learning Summary Training Session Evaluation Detailed instructions, including examples, for each of these items are provided in the following pages. Additional Forms in this Application that Might Apply to Your Training Summary Evaluation for Training Session Template - use this template as a model for designing your Summary Training Session Evaluation. Application for Individual RESNA-CEUs - This form applies only to those training sessions for which attendees will request their RESNA-CEU documentation from RESNA instead of receiving it directly from the training provider. Typically, this form is used for training courses that are offered to a broad audience, in which only a segment of the audience will request RESNA-CEU documentation. The training instructor prefills the form with the course name, date and sponsoring organization, and then provides attendees with copies. The instructor then directs attendees to complete the remainder of the form and submit for submission to RESNA along with the $16.00 individual payment of the $16 per-head processing fee. Conference Session Attendance Tracking Template - This form applies only to training presented at conferences. The conference host must implement a strategy for tracking attendance at sessions that award RESNA-CEUs. Many conferences use a badge scanning system for this purpose. However, in the absence of an electronic tracking system, RESNA suggests a model in which each session is assigned a tracking number that the instructor will provide to the attendees only at the end of the session. This template may be used to provide directions to the Instructor. Note: additionally, the conference host would provide attendees with a CEU Tracking Form, and the attendee would record session tracking numbers on the tracking form as proof of attendance. To request a CEU Tracking From template, contact RESNA.
Speaker RESNA-CEU Agreement In order for RESNA to provide RESNA-CEU credit for a training session, this agreement must be signed by each instructor for the session. I agree to adhere to the following criteria set forth by RESNA in order for RESNA to provide RESNA-CEU credit for this session. I understand that my session, has been approved for RESNA-CEUs because the proposed structure and format that I discussed in my application meet the criteria set by RESNA. Therefore, I understand that my session should follow my proposed format and I agree to the following conditions: 1) My approved session will address the training goal and the instructional objectives (minimum of 4) stated in my application, which were developed based on a training needs assessment. At the onset of my presentation, I will announce the instructional objectives for that session. 2) Structured teaching methods will be used to help participants meet the proposed training goal and instructional objectives. 3) I will fully disclose any proprietary interest in any product, instrument, device, service, or material discussed during the program. 4) I will maintain a high standard of professionalism and I will not discriminate or make discriminatory remarks based on gender, ethnicity, religion, age, disability, socioeconomic status, and/or sexual orientation. I also understand and agree to the following RESNA requirements that must be met in order for this session to receive RESNA-CEUs: 5) The participants of this session are required to complete an assessment of learning, as approved by RESNA in the RESNA-CEU sponsorship application. 6) The participants are required to complete a post-session summary evaluation of the session and instructors, as approved by RESNA in the RESNA-CEU sponsorship application. 7) Participants are required to be present for at least 85% seated time in the session, as approved by RESNA in the RESNA-CEU sponsorship application. 8) RESNA Guidelines state that as an instructor of this session, I cannot apply for nor can I receive RESNA-CEUs for this session. Instructor signature: Date: Instructor name (printed): Mail this application with payment to: RESNA-CEU Sponsorship, 1700 N. Moore St, Suite 1540, Arlington VA 22209. If paying by credit card, email it to certification@resna.org.
Criteria for RESNA-CEU Co-Sponsorship 1. Needs Assessment The Needs Assessment must describe how professional educational needs were determined for this training. Explain the process you used, who was involved, and which training needs were identified. (Please limit response to no more than one page.) Training needs assessment may be developed by interviewing key individuals, reviewing existing data (records, reports, samples, media, and previous training session evaluations), conducting focus groups, or by surveying a sample population. It is preferred that two or more of these techniques be used for gathering data on training needs. 2. Planned Training Goal and Instructional Objectives Please express the training goal in one or two sentences. The training goal should reflect the information gathered through the Needs Assessment. Then, list four instructional objectives that identify specifically what the instructor will teach in order to meet the training goal. Instructional Objectives should reflect what will be demonstrated, explained or shared during the training program. Example: Training Goal: This program will provide objective information related to selecting an appropriate pelvic positioning device for wheelchair seating. Instructional Objective #1: The instructor will describe the clinical implications of body mechanics and the physics of force for a person in a seated posture. Instructional Objective # 2: The instructor will describe/explain/demonstrate: Instructional Objective # 3: The instructor will describe/explain/demonstrate: Instructional Objective # 4: The instructor will describe/explain/demonstrate: 3. Training Session Description Submit an abstract description of the training. The write-up should be titled Training Description and limited to 750 words. Following the abstract, include a statement to indicate whether the training requires prerequisite knowledge or skills. 4. Teaching Methods and Time Allocation For courses up to four hours in length, submit a write-up titled Teaching Methods and Time Allocation. This should indicate training session start and stop times and the start time / length of breaks. Include any instructional support and materials (e.g. handouts) that will be provided. Also include a list of topics/sections covered by the instruction. For each topic listed, provide the following details: the presenter of that topic (if there are multiple presenters for the training session); the amount of instructional time spent on that topic; instructional method (e.g. lecture, photos, video) and class activities if any (e.g. game, role play, hands-on demo); which instructional objective(s) is/are targeted. For courses longer than four hours, complete and submit the Teaching Methods and Time Allocation table on the following page.
Teaching Methods and Time Allocation Table (for courses longer than 4 hours) For courses two days or longer, complete this page for each day of the course. Please provide an hour-by-hour breakdown of topics, instructional methods, and learning activities that will be used. Provide enough detail so reviewers will have a clear idea about course content and instructional design. If there are multiple presenters, please specify the presenter name for each hour. For each topic presented, the following details are needed: the presenter of that topic, the amount of instructional time spent on that topic, instructional format, class activities, and which of the specified learning objectives is/are targeted. Course start time: Course Stop time: Planned breaks (time and length): Topic Instructional Objective(s) (from Criteria 2) Instructional format and class activities Time (Minutes) Presenter Name(s) Hour #8 Hour #7 Hour #6 Hour #5 Hour #4 Hour # 3 Hour # 2 Hour # 1
Criteria for RESNA-CEU Co-Sponsorship (cont d) 5. Assessment of Learning Describe the assessment of learning to be used for this training session, including how attendees mastery of the content will be measured, and how this data will be used to provide feedback to attendees and to the instructor. An assessment of learning must measure attendees mastery of the knowledge and skills presented in the learning objectives. This assessment serves two purposes: to give attendees feedback about their mastery of the training material to give the instructor(s) feedback about whether attendees are generally mastering the training material. If hands-on application of a skill must be demonstrated, then the assessment must include some observation of the demonstrated activity during the learning event, with feedback from qualified reviewers or the instructor. For lecture-style training, the assessment could be in the form of a short quiz to be completed by attendees, in which attendees are provided with an answer key to self-score their performance. Attendees then submit the quiz (or simply report their score anonymously) to the training coordinator. For quiz-style assessments, the quiz should include one question for each instructional objective. Questions should be multiple-choice with four independent answer options. (Avoid using all of the above or none of the above as answers.) Example of an assessment question that addresses the instructional objective, Describe the clinical implications of body mechanics and the physics of force for a person in a seated posture : What is the correct direction of force applied by a rigid pelvic positioning system? a. Rearward towards the wheelchair occupant b. Downward towards the wheelchair occupants thighs c. At a 45 degree angle to the seat and back of the wheelchair d. At an angle which promotes posterior tilt of the pelvis 6. Summary Training Session Evaluation Submit a copy of the Summary Evaluation of the Training Session that will be provided at the conclusion of the event. The evaluation must collect data to address continuous improvement of the training course. You may use the Summary Evaluation Template on the next page as a model.
Summary Evaluation for Training Session Template Course Name: Date: Course evaluation. For each item below, please circle a number at right to indicate your rating: (5=Excellent, 4=Good, 3=Satisfactory, 2=Less than Satisfactory, 1=Poor) 1. Overall quality of the workshop 5 4 3 2 1 2. Organization of the workshop 5 4 3 2 1 3. Usefulness of materials 5 4 3 2 1 4. Outlining of instructional objectives 5 4 3 2 1 5. Technology-enhancement of the presentation 5 4 3 2 1 Instructor evaluation. For each item below, please circle a number at right to indicate your rating: (5=Excellent, 4=Good, 3=Satisfactory, 2=Less than Satisfactory, 1=Poor) Instructor 1: 1. Presenter s preparedness to deliver content 5 4 3 2 1 2. Presenter s knowledgeability 5 4 3 2 1 3. Presenter s organization of the content 5 4 3 2 1 4. Presenter's teaching style 5 4 3 2 1 5. Opportunities to ask questions and receive feedback 5 4 3 2 1 6. Information for contacting presenter later 5 4 3 2 1 Instructor 2: 1. Presenter s preparedness to deliver content 5 4 3 2 1 2. Presenter s knowledgeability 5 4 3 2 1 3. Presenter s organization of the content 5 4 3 2 1 4. Presenter's teaching style 5 4 3 2 1 5. Opportunities to ask questions and receive feedback 5 4 3 2 1 6. Information for contacting presenter later 5 4 3 2 1 Instructor 3: 1. Presenter s preparedness to deliver content 5 4 3 2 1 2. Presenter s knowledgeability 5 4 3 2 1 3. Presenter s organization of the content 5 4 3 2 1 4. Presenter's teaching style 5 4 3 2 1 5. Opportunities to ask questions and receive feedback 5 4 3 2 1 6. Information for contacting presenter later 5 4 3 2 1 Do you have suggestions for improving this course/session? What topics would you like to see covered at future web-based and in-person training sessions? YOUR NAME is required for RESNA-CEU credit (PLEASE NOTE: This is only for attendance verification purposes -your name is REMOVED from this form before instructors view it.) NAME
APPLICATION FOR INDIVIDUAL RESNA-CEUs To be completed by training provider: Training Session name: Date of Training Session: Sponsoring Organization: To be completed by training session attendee: PLEASE PRINT CLEARLY! First Name: Last Name: Address: Telephone Number: Email Address: Fee: $16.00 Paid by:! Check! Purchase order! Mastercard! Visa If paying by check, please make checks payable to (Your Institution s Name) Check # If paying by credit card, please provide the following: Credit Card Number: Expiration Date: 3 Digit Code (on back of card) Name on Card: Billing Address of Card: I hereby verify that the information contained in this application is correct, and I have read and understand the learning objectives of this conference. Signature: Date: Mail this form with your payment to: RESNA-CEU Documentation, 1700 N. Moore St, Suite 1540, Arlington VA 22209. If you are paying by credit card, you may alternatively scan this form and email it to dpaulson@resna.org.
Conference Session Attendance Tracking Template: Instructions for the Instructor / Room monitor / Session Chair IMPORTANT: This Number MUST be read at ALL Sessions! Course Name: Instructor / Room monitor / Session Chair: Date:, Room #: Session tracking number: This number MUST be announced at the end of each session. Persons seeking RESNA CEUs must record this number on their CEU Tracking Form. Please remind attendees of the following information: This session s tracking code number must be recorded on your CEU Tracking Form. Forms for this purpose are available at the registration desk. Also, if you want RESNA-CEU credit for this session, you MUST complete the course s Assessment of Learning and the Summary Evaluation. (Note: if the Assessment and the Evaluation are being conducted by paper, then remind attendees to give the completed documents to the room monitor.)