Forms & Documents

 Working with PACE 

Activity Planning Form (Short Form)
Complete this form first and submit to PACE. 
 Anyone with an idea or specific need for a continuing education activity
Activity Planning Form (Long Form)


Budget Planning Document
Once PACE reviews and approves the initial planning form, this form will gather additional information and provides standards of excellence for activity planning.
Internal faculty or departments and potential external joint sponsors that have received tentative approval for activity planning.
 Specialty Programs

Performance Improvement CME Request

Performance improvement (PI) CME activities describe structured, long term processes by which a physician or group of physicians can learn about specific performance measures, retrospectively assess their practice, apply these measures prospectively over a useful interval, and re-evaluate their performance. Anyone with an idea or specific need for a continuing education activity
Monograph Request  Use this form to suggest a CME-certified printed monograph.
 Original authors or co-authors

AOA Preceptor Credit Reporting Form

Department liaisons should use this form to report preceptor credit to the PACE Office. Clinical/Educational Department Liaisons

AOA Teaching Credit Reporting Form

Department liaisons should use this form to report teaching credit earned by faculty members to the PACE Office. Clinical/Educational Department Liaisons

AOA Healthcare Facility Report

Hospital Education Representatives with whom PACE works should use this form to report educational activities at a healthcare facility. Hospital Education Representatives

Credit Request Form

Use this form to request credit for a UNTHSC-sponsored activity you have attended if you have misplaced the form you received at the activity. Healthcare providers requesting credit for a CME or CE activity

PRA AMA Category 2 Self-Documentation Form

Use this form to document PRA AMA Category 2 credits in your files AMA-member physicians who have earned category 2 CME credits (not sponsored by an accredited provider)

Faculty Expense Report Form

General form for faculty members requesting travel expenses or speaker fees CME or CE faculty members who have misplaced the original expense report

Disclosure and Conflict of Interest Resolution Policy

UNTHSC's policy on identification and resolution of conflict of interest Any internal or external presenter, reviewer, writer, planning committee member or joint sponsor.

Blank Letter of Agreement

UNTHSC's standard Letter of Agreement for Commercial Support Potential commercial supporters

Policy on Disclosure of Relationships with Commercial Interests
Faculty disclosure and conflict resolution policy
Anyone involved in a CME or CE activity.



Call for Presentations

Use this form to submit a CME-or CE-certified presentation you would like to provide. Potential presenters

Certificate Request(fax)

Request a certificate or detailed log of events of UNTHSC-sponsored activities you have attended.
Activity participants

ACCME Standards of Commercial Support

The most current Standards of Commercial Support released by the ACCME Commercial supporters, joint sponsors and/or attendees

CME/CEU Requirements by State

A listing of CME requirements by state Physicians
Rand Horsman Staff Scholarship $1,000 scholarship to provide assistance for a Health Science Center (HSC) employee and/or an employee’s dependent who are continuing their education. Health Science Center (HSC) employee and/or an employee’s dependent who are continuing their education

This page last updated 12th Nov 2013