Continuing Pharmacy Education Activity Application Form 4430

If this is your first time to fill out this form or if you have questions about any of the information requested below, please see the "Speaker Guide."

All materials must be submitted no later than 15 days prior to educational activity date in order to file for continuing pharmacy education (CPE) credit with the Accreditation Council for Pharmacy Education (ACPE).

Asterisk (*) indicates a required field.

Primary Contact Information
General Activity Information
Activity Place, Date, and Time
Time of Activity
Activity Objectives

List activity objectives (Pharmacists)

List activity objective (Pharmacy Technicians) (must be different from those of Pharmacists if this is a joint activity)

Type of Activity
Activity Key Words
Active Learning