NSM Course Application

NSM Application for External CEU Course Invoiced

This form must be completed and submitted electronically. iNRRTS is an accredited IACET provider and is pleased to offer CEUs for Learning Events including Live Webinars, On Demand Webinars, and Live Learning Events. If you are interested in having your learning event approved for CEUs, please complete the iNRRTS CEU Application below. Later in this application, you will be asked to upload a quiz, if needed, and the iNRRTS Speaker Agreement. Please make sure that all presenters have completed the agreement and that you have it / them ready to upload.

Date of Application*
MM slash DD slash YYYY
Start Date for the Course*
MM slash DD slash YYYY
Course Title*
CEU Value requested*
.1 CEU = .1 Contact Hour
- .1 CEU - 1 hour course (3 learning outcomes)
- .2 CEU - 2 hour course (4 learning outcomes)
- .3 CEU - 3 hour course (5 learning outcomes)
- .4 CEU - 4 hour course (6 learning outcomes)
- .5 CEU - 5 hour course (7 learning outcomes)
- .6 CEU - 6 hour course (8 learning outcomes)
- .7 CEU - 7 hour course (9 learning objectives)
- .8 CEU - 8 hour course (10 learning objectives)
If you are requesting more than .8 CEUs, please contact the Education Manager, Kathy Fisher, at kfisher@nrrts.org
Name of Organization or Company*
The name of the company or organization that is hosting this course.
Name of Contact (Authorized Company Representative)*
First Last
Email*
Enter Email Confirm Email
Phone*
Company Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Marketing the Event
Marketing brochure or online promotion of the course(s) must include:
- - Course description
- - Learning outcomes
- - Registration details
- - Speaker bio, credentials
The following statement must also be included:
iNRRTSCE is certifying the educational contact hours of the program and by doing so is in no way endorsing any specific content, company, or product. The information presented in this program may represent only a sample of appropriate interventions. As an IACET Accredited Provider, The International Registry of Rehabilitation Technology Suppliers offers CEUs for its programs that qualify under the ANSI/IACET Standard. This course is approved for _____ CEU.
Upload a copy of the proposed marketing material related to the course.
Max. file size: 50 MB.
Course Type*
Online learning events require a quiz with a minimum 5 Questions for each 1-hour course and 10 questions for a 2-hour course. Not required for Classroom Learning (face-to-face) Events.
- Live Webinar with Quiz
- On Demand Webinar with Quiz
- In-Person Learning Event with Quiz
- In-Person Learning Event No Quiz
Target Audience
Target Audience*
Hold CTRL key to for multiple selections
Needs Analysis - the need for this course was determined by*
Justification for this topic.*
Please describe the outcomes for each of the Needs Analysis items selected above.
Assessment Method and Performance Criteria
As stated earlier, online learning events require a CEU quiz with a minimum 5 Questions for each 1-hour course and 10 questions for a 2-hour course. A quiz is not required for Classroom Learning (face-to-face) Events. If you are NOT submitting a quiz with the application, please email it to snoelting@nrrts.org no later than three weeks prior to the event.
Upload CEU quiz*

Accepted file types: doc, docx, jpg, gif, png, pdf, Max. file size: 50 MB.
Please Select the Passing Score for this Quiz.
- 90%
- 80%
- 70%
- 60%
Speaker/Presenter Information
Will more than one speaker be approved to present this course?
- Yes
- No
Speaker 1 Name, Credentials, Bio*
Provide the speaker's professional qualifications to present this topic and include a short bio on each speaker describing their professional experience. If there are more than three (3) presenters, please complete this form with the first three presenters and contact Kathy Fisher, Education Manager, at kfisher@nrrts.org.
Speaker 1 Name Speaker 1 Credentials
Speaker 1 Bio*
Speaker 2 Name, Credentials, Bio
Speaker 2 Name Speaker 2 Credentials
Speaker 2 Bio
Speaker 3 Name, Credentials, Bio
Speaker 3 Name Speaker 3 Credentials
Speaker 3 Bio
Communication Method*
How will learners, and others communicate with you, the speaker? This information must be provided before the learning event.
How will you document and verify attendance?*
Learning Designs
Enter the methods and the media used to present the learning outcomes.
Instructional method used to present the content for the following learning outcomes*
- Power Point
- Lecture
- Discussion
Media used to support learning outcomes*
- Handout
- Images
- Videos
- Charts
- Case Studies
Learning Outcomes
Learning outcomes must be expressed as specific and measurable objectives of the course being presented. The time allocated for each learning outcome must reflect the total course instruction time of a minimum of 50 minutes per .1 Continuing Education Unit. Learning outcomes must be presented at the beginning of the presentation,
Learning Outcome #1*
Number of minutes alloted for this learning outcome*
If you use the 'Other' option, please use only numeric characters.
- 10
- 15
- 20
Learning Outcome #2*
Number of minutes alloted for this learning outcome*
If you use the 'Other' option, please use only numeric characters.
- 10
- 15
- 20
Learning Outcome #3*
Number of minutes alloted for this learning outcome*
If you use the 'Other' option, please use only numeric characters.
- 10
- 15
- 20
Learning Outcome #4*
Number of minutes alloted for this learning outcome*
If you use the 'Other' option, please use only numeric characters.
- 10
- 15
- 20
Learning Outcome #5*
Number of minutes alloted for this learning outcome*
If you use the 'Other' option, please use only numeric characters.
- 10
- 15
- 20
Learning Outcome #6*
Number of minutes alloted for this learning outcome*
If you use the 'Other' option, please use only numeric characters.
- 10
- 15
- 20
Learning Outcome #7*
Number of minutes alloted for this learning outcome*
If you use the 'Other' option, please use only numeric characters.
- 10
- 15
- 20
Learning Outcome #8*
Number of minutes alloted for this learning outcome*
If you use the 'Other' option, please use only numeric characters.
- 10
- 15
- 20
References/Resources*
Please list a minimum of 3 references/resources used to support this material.
Speaker Agreements
Upload the speaker agreement(s) as a PDF or an image file.
Upload Speaker Agreement as a PDF, JPG, PNG, or docx file*
Accepted file types: pdf, jpg, gif, png, doc, docx, Max. file size: 50 MB.
Upload Multiple Documents as needed.
Drop files here or

Max. file size: 50 MB.
Payment
Number of Presentations*
- 1-10 presentations per year at $500
- 11 or more presentations per year at $700

Speaker 1 Name	Speaker 1 Credentials

Speaker 2 Name	Speaker 2 Credentials

Speaker 3 Name	Speaker 3 Credentials

NSM Application for External CEU Course Invoiced

Marketing the Event

Target Audience

Assessment Method and Performance Criteria

Speaker/Presenter Information

Learning Designs

Learning Outcomes

Speaker Agreements

Payment