Application for Accreditation of CPE Point for Pharmacist Training Activity(Non-accredited CPE Programme Provider)

Application for Accreditation of CPE Point for Pharmacist Training Activity
(Non-accredited CPE Programme Provider)

Remarks

- Please complete the following form for your upcoming activity to be accredited. We will review your submission within 7 to 14 working days.
- For inquiries or urgent application, please contact cuhkcpe@pharmacy.cuhk.edu.hk.

1Activity Information > 2Contact Information > 3Declaration
Name of Organiser/ Institution:
Co-organiser(s):

N/A if not applicable
Sponsor(s):

N/A if not applicable
Title of Activity
Learning Objectives
Type of activity

Type of activity Conference Seminar Meeting Workshop Forum Other (please specify) Other (please specify)
Nature of Delivery

Nature of Delivery Physical Attendance Online with Live Streaming Online (On Demand) Hybrid (Physical Attendance + Online with Live Streaming) Hybrid (Physical Attendance + Online (On Demand)) Other (please specify) Other (please specify)
Is it a one-day activity?

Is it a one-day activity? Yes No
Number of days involved

Number of days involved 2 days 3 days 4 days Other (please specify) Other (please specify)
Date, Time & Duration

Format:
Session/Day 1: DD/MM/YYY; From HH:MM to HH:MM; X hours
Session/Day 2: DD/MM/YYY; From HH:MM to HH:MM; X hours
Date Date / MM / DD YYYY
Start time of the activity Start time of the activity : HH MM AM/PM
End time of the activity End time of the activity : HH MM AM/PM
Duration of the activity (in hour)
How many speaker do you have during the activity(ies)?

How many speaker do you have during the activity(ies)? 1 2 3 4 or above
Name of speaker (#1) Name of speaker (#1) First Last
Title of the speaker (#1)
Qualifications & current practice/affiliation of the speaker (#1)
Name of speaker (#2) Name of speaker (#2) First Last
Title of the speaker (#2)
Qualifications & current practice/affiliation of the speaker (#2)
Name of speaker (#3) Name of speaker (#3) First Last
Title of the speaker (#3)
Qualifications & current practice/affiliation of the speaker (#3)
Please provide a website / documents with the list of speakers & qualifications

Attach Files
Venue
Estimate Number of Participant (Registered Pharmacist)
Must be a number greater than or equal to 1.
Additional information about the CPE Activity (e.g. Social Media Post, Poster etc.)

Attach Files
Contact Information (will be shown to the public on CPE Administrator's and PPB's website)
Name Name First Last
Email
Number
If you have more then one activity to be submitted, please fill-in the new form again after completing the current submission.
Disclaimer The personal data collected will be used by School of Pharmacy (PHA) and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.

Application for Accreditation of CPE Point for Pharmacist Training Activity(Non-accredited CPE Programme Provider)

Contact Information (will be shown to the public on CPE Administrator's and PPB's website)

If you have more then one activity to be submitted, please fill-in the new form again after completing the current submission.

Application for Accreditation of CPE Point for Pharmacist Training Activity
(Non-accredited CPE Programme Provider)