CPD Course Application Form - Board of Accreditation and Licensure of Medical Laboratory Technology

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Recommended if applying to Liberia Board of Accreditation and Licensure of Medical Laboratory Technology (BALMLT)

CPD providers must complete and submit this form for a course to be approved as Category A (accredited CPD course) content and assigned Continuing Education Units (CEUs) that count towards licensure requirements. Before completing this form, ensure that your organization is registered as a CPD provider.

* Name of CPD Provider

* Contact Person

* Job Title of Contact Person

* Phone Number of Contact Person

* Email Address of Contact Person

* Physical Address of Contact Person

* Website

* Current CPD Provider Registration Expiration Date

For each Facilitator, complete the below cell (1 sentence for each facilitator) and attach their CV

Name | Educational Qualifications | Professional Experience | Current Position & Employer | Any other experience related to the topic? Name, Educational Qualifications, Professional Experience, Current Position & Employer and ny other experience related to the topic

* Course Title

Describe how participants will sign-up or be selected. For CPD courses targeting specific individuals, explain how those individuals are prioritized.

How long is the course? If occurring over multiple days or months, describe how the hours will be divided up.

Proposed CEUs for Course: 1 hour = 0.1 CEUs

* Select the proposed course format. If hybrid, provide additional details of the breakdown.
In-person trainingOnline
Hybrid (explain):

In 1-3 sentences, describe the need for this course. What health challenge is being addressed? What best practices will be taught? What evidence informs the proposed content?

By the end of the proposed CPD course, participants will be able to. . .

For CPD courses that are more than 4 hours long, a session plan is required. You may add additional rows to the template below if needed.

Session Topic | Facilitator | Duration | Session Objectives | Learning Activities Session Topic, Facilitator, Duration, Session Objectives and Learning Activities

What requirements must participants fulfill to successfully complete the course? This may include some combination of attendance, completion of assignments, and achievement of a certain score on assessments (e.g. post-test, skills observation such as an OSCE).

Describe how the course will be evaluated to inform ongoing improvement in CPD content and delivery. This may include post-course surveys by participants, an after-action review, etc.