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CHLM Approval Program Application
Program Title
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Applicant Contact Information (Name, Address, Email, Phone #)
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Are you a Constituent Organization of AAPA?
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Yes
No
Are you applying for AAPA CME credits for this program?
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🛈
Yes
No
Start Date
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End Date
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Location
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Target Geographic Reach
National
State
Regional
Local
Healthcare System Catchment Area
International
Other
CHLM Endorsement Application
Program Description
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0/500 characters
Upload Program Agenda
Explain how the program aligns with CHLM's mission statement:
"The AAPA Center for Healthcare Leadership and Management (CHLM) provides advisory services, programs and expertise on optimizing provider practice. CHLM offers a wide range of professional development resources geared toward fostering leadership and management skills in the healthcare setting."
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0/500 words
What methods were used to determine the need for this activity (check all that apply)?
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Survey Results of Potential Learners
Evaluations from Previous Activities
Needed Health Outcomes
Identified New Skills
Literature Review
Quality Improvement (QI) Data
Federal/State Government Mandate
Informal Feedback
Focus Group
Planning Committee
Expert Opinion
Other
Other
Instructional Method (Check all that apply)
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In Person Conference
Live Webinar
Live Teleconference
Print/Monograph
Journal-based CME
CD
DVD
Archived Live Program
Online Interactive Educational Module
Quality Improvement Activity
Performance Improvement CME
Online Video
Other
Other
Audience Group
Physicians
PAs/NPs
Pharmacists
Other
Estimated # of Participants
Audience Group
Physicians
PAs/NPs
Pharmacists
Other
Estimated # of Participants
Audience Group
Physicians
PAs/NPs
Pharmacists
Other
Estimated # of Participants
Audience Group
Physicians
PAs/NPs
Pharmacists
Other
Estimated # of Participants
What are the core competencies of the program (Check all that apply)?
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Practice Based Learning and Improvement
Professionalism
System Based Practice
Patient Care
Interpersonal and Communication Skills
Medical Knowledge
If you are selected for approval, CHLM will display your program or company logo on our website. Please upload a high resolution logo that you would like to be displayed:
Program's URL to direct potential participants:
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If approved, the Approval Agreement is in effect, and CHLM grants the approved party a nonexclusive revocable worldwide license to use CHLM's trademarks, logos and marks during the term of the agreement in connection with the specified CHLM Approval Program, hereafter referred to as the Program, as defined herein, provided that the approved party shall not sublicense or otherwise transfer its rights to CHLM's trademarks, logos and marks to any other party for any reason. The Program shall remove or make inactive the CHLM Approved logo 30 days after the Program has ended. The approved party shall not alter, modify, dilute, misuse, bring disrepute or challenge CHLM's ownership rights in its trademarks, logos and marks. The approved party shall follow the approved CHLM Approval Program Branding Guide. This agreement expires annually from the date of approval.
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I agree to the terms above
Thank you for your submission to CHLM. You will receive an email shortly from a staff member at CHLM to submit payment. We will contact you within 30 days to notify you if your event has been accepted. All decision on approval by CHLM are final and cannot be appealed.
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