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Education

Application for Renewal
MLA Continuing Education Activity

This CE Renewal Application may be used only by instructors whose approval expired less than one year prior to this submission. Download the PDF file of this application or print out this Web page, then complete the application as instructed and send it to MLA headquarters at the address listed below.

To top of page General Instructions

Follow the italicized directions to prepare your proposal as a separate word processing document using 12-point typeface. Use outside margins of at least 1". Type the course title and page number in the top right corner of each page. Identify the numbered sections of the proposal, and double-space between sections.

This application should be completed and turned in by the instructor of the education activity. It should not be filled out by the sponsoring organization, (e.g. MLA chapter, local consortium, etc.).

Current educational activity title & current date of approval:

List the current CE title as submitted for previous MLA approval.

To top of page Changes to the Current Application

Please list major changes that have occurred to the education activity. If no changes have occurred, please answer the question as "no change". Refer to current application for a definition of each category.

  1. New title:
    List new title of CE activity.
  2. Type of CE activity:
    • A. Select one of the types of activities listed below.
      MLA's national annual meeting CE course proposal, other CE course proposal, symposium, web-based CE course, or other CE activity (please list type of activity)
    • B. For already scheduled activities provide information listed below.
      Sponsor, MLA chapter/regional location, location and date of activity, time, fee and registration information (contact name, address, phone, fax, and email).
  3. Primary contact:
    Other instructor(s): Please list all new faculty members. List any instructors from previous applications that are no longer teaching.

    Give name, MLA ID#, MLA chapter/regional location, institutional affiliation, position, mailing address, phone, fax, and email address for each new instructor. Briefly explain the qualifications of each new person, both in terms of subject area knowledge as well as teaching competency and experience in adult learning. Indicate which instructor will be the contact of MLA. Include a curriculum vita for each new instructor in the application packet.
  4. New Course length:
    Specify the length of the course if changed. For MLA's national annual meeting CE courses are typically 4, 6, or 8 contact hours in length.
  5. New description:
    If description is different from the one currently listed on MLANET Educational Clearinghouse, (http://www.mlanet.org/education/cech/index.php3), please provide.

    Provide a brief summary of the major concepts and goals of this class or CE activity linking to stated educational objectives; maximum 150 words. Include the overall goal, behavioral objectives or outcomes anticipated, specific content, and methods of the proposed CE activity. This description will be used on MLANET. For courses accepted for the MLA annual meeting, this summary will be used in the preliminary program.
  6. New target audience: Prerequisites: Level of instruction:
    List any changes to the target audience that will benefit from the activity. List any new prerequisites or change in the intended instructional level, i.e. basic, intermediate, or advanced level of instruction.
  7. New educational objectives:
    Provide any new educational objectives.
  8. New agenda with timeline:
    Provide a new detailed agenda and timetable.
  9. New method of delivery:
    Provide any new methods of delivery.
  10. New educational needs:
    Provide any new educational needs.
  11. New instructional methods:
    List instructional methods to be used. They should be consistent with the course content and delivery system and should encourage active involvement by the course participants. Select methods from this listing or specify others:
    Lecture
    Discussion
    Simulation
    Case Method
    Other
    Demonstration Debate Role playing Case study  
    Slides Dialog Gaming Problem-based  
    Learning videotape Brainstorming In-basket activities Critical incident  
    Panel discussion Sharing/self-disclosure Hands-on exercises    
  12. New participant materials:
    Please send sample copies of new participant materials. If the final versions are not available at application time, please send current materials.
  13. New facility requirements:
    Provide any new special facility requirements for the course or activity. Include AV and other classroom aids, computers software, Internet access, and seating arrangements.
  14. New evaluation:
    Please include a sample of each new evaluation tool or technique.
  15. Fees:
    Determine which of the fees listed below is appropriate for your application, and enclose payment if required. Each application must be accompanied by fee payment unless the course is proposed for an annual meeting. Fees for courses being proposed for the annual meeting will be deducted from the instructor's honorarium if selected.
    MLA members$ 75.00
    Non-members$125.00
    Institutional groups (i.e. vendors, hospitals, universities)$175.00
    NLM, Regional Medical Libraries, national professional library associations with MLA agreements$ 0.00
    Late fee for applications received by MLA 6 weeks or less from the presentation date.$ 45.00

To top of page Checklist of enclosures:

  • CE Course/Activity Proposal
  • Fee (if applicable) - make checks payable to Medical Library Association
  • Detailed agenda
  • Curriculum vita for each instructor
  • Participant materials
  • Evaluation form (optional)
Submit completed application packet to:

Kathleen Combs
Professional Development Department, Medical Library Association
Suite 1900, 65 East Wacker Place
Chicago, IL 60601-7246
Fax: 312.419.8950
Email: mlapd1@mlahq.org

For more information, contact Kathleen Combs, CE coordinator: 312/419-9094 x29 or mlapd1@mlahq.org


Revised 10/02

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