Ascension Providence Hospital Application

Attached, please find the information you will need to apply for your CME activity. The following is a list of directions to help assist you in completing your application:


Course Director completes the following forms:

  1. Application
  2. Course Director's Agreement
  3. Commercial Agreement (upon completion, the Course Director has the vendors sign as well.)
  4. Exhibitor Application (No Commercial Agreement required if vendor only wants an exhibit/display)
  5. Resolution of Conflict (see Disclosure Form below)


Your speakers should complete the following:

  1. Disclosures Form (If there are any conflicts...the Course Director would then complete the Resolution of Conflict form and attach it to the Disclosure form for that particular speaker. Speakers MUST submit a Disclosure, Good Practices Agreement, and CV disclosing relevant financial relationships regardless of support from any commercial interest, and that false disclosure or failure to resolve Conflicts of Interest will result in replacement of speaker, removal of speaker, or denial of CME credit).
  2. Good Practices Agreement


Additional Information:

If a conference has no speaker…please provide a certified attendance roster and minutes.


Mandatory for CME Approval

The conference must be "DIRECT PATIENT CARE". It should be appropriate “QUALITY IMPROVEMENT ACTIVITY" with regards to patient care.


If you have any additional questions or concerns, please feel free to contact Eutropia Rhodes at (248) 849-2203.