Elective CME Pre-Approval Form

Submit a RequestEnsure to enter your ESH# at the bottom of the form.
You may attach a file below to help support your request.

Title of CME Event(*)
Please enter paramedic's name.

Date of CME Event(*)
Please enter a valid date.

CME Hours Requested
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Education Methods
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Use CTRL+Click to select more than one option.

What is the clinical value of this elective CME?(*)
Please provide the detail of your request.

What new knowledge will you gain?(*)
Please provide the detail of your request.

Is the CME focused on low frequency, high acuity skills as a paramedic?
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Please provide details
Please provide the detail of your request.

Have you participated in the same activity for CME in the past?
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how many years ago?
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Attach file
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Maximum size 8 MB.

EHSN
EHSN is a five digits number.

Name of person submitting(*)
Please enter your full name.

Email(*)
Please enter a valid email address.

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