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Course Coordinator Forms

UCLA Health and the Department of Nursing Research & Education thank all our Course Coordinators for their ongoing investment in developing high quality educational events. 

Please be prepared to submit the following documentation. Note that there are no longer separate forms for BRN and ANCC offerings. The NRE Initial Course Contact Form, Planning Template and Disclosure of Conflict of Interest forms are required for all educational activities awarding contact hours.

NRE Initial Course Contact Form
Planning Template
Logistical Support Request Form
Disclosure of Conflict of Interest Form

We encourage you to work with NRE to create personalized flyers and other materials to advertise your event. Contact your NRE Nurse Planner for more information.  Statements referring to contact hours on all flyers and course material must adhere to strict guidelines.  Do not distribute materials that indicate the type or number of contact hours until approved by NRE.

Save-the-Date Template
Flyer Template


To learn more about becoming a Course Coordinator and for course planning tip sheets, see Getting Started: How to Plan an Educational Activity, which details the following Five-Step process for putting on an educational activity.

Step 1:  Complete the NRE Initial Course Contact Form.  You will be contacted by an NRE Nurse Planner to discuss the details of the activity.

Step 2:  Submit the Planning Template & Logistical Support Request Form no later than 6 weeks prior to activity.  Email documents directly to your assigned NRE Nurse Planner.

Step 3:  Submit the Disclosure of Conflict of Interest Form and a CV/Resume (updated within 2 years) for each planner/presenter no later than 2 weeks prior to activity.  Email documents directly to your assigned NRE Nurse Planner.

Step 4:  Submit all course material, including presentations & handouts no later than 2 weeks prior to activity.  Email documents directly to your assigned NRE Nurse Planner.

Step 5:  Submit post course materials, evaluations and attendance sheet no later than 2 weeks after the activity.  Email documents directly to your assigned NRE Nurse Planner.


Be advised that NRE is working to update the Course Coordinator form submission process. Please anticipate updates to this process.  As of July 1, 2016 only the forms provided on this webpage will be valid for requesting contact hours.  Old versions of course planning templates, tables and other forms will not be accepted.

We appreciate your patience as we continue to improve this process.

For more information on planning a course, useful definitions, tip sheets related to course planning, and templates, see: Getting Started: How to Plan an Educational Activity

NRE appreciates any feedback on our website, forms and process for submitting educational activities for contact hours:
Comments & Suggestions

For questions, contact:
Kathleen Feldman
Nursing Professional Development Specialist
Department of Nursing Research & Education
kfeldman@mednet.ucla.edu 

Revised 5/2016 

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