Accredited Approver Unit
Activity Application Checklist and Instructions
List of Required Materials



This Checklist is here to aid the applicant in gathering the information, documentation, and resources necessary during the process of submitting an Activity Application. You will find links to documents and templates below, provided in several formats to accommodate different word processors and computer operating systems.    






Welcome to the ANA Massachusets Approver Unit electronic activity application. Please carefully read the following instructions before you begin your application.

Step one: REGISTRATION

Obtaining Username and Password, Nurse Planner Signature Code, and Registering the Organization

In order to submit an application you will need to have a personal login username and password, a Nurse Planner signature code, and an organization ID code.

Personal login username and password When you click the “sign up” link on the login page you will create a user name and password and then receive approval by email. You get to the login page when you click on the “Online Program Application Submission” link on the Menu of the home page

Nurse planner signature code When you register as a nurse planner you will be sent a signature code. This is your electronic signature on this and any future applications you submit, regardless of the organization you represent. You are responsible for any information submitted using this identification number. Please keep it in a secure location and do not share it with anyone.

Organization Each organization for which an application is being submitted, will need to be registered. This registration process is a onetime event for each organization, and this registration code is the Organization ID that will be used to link all future files pertaining to the organization to ANA Massachusets Approver Unit. In order to obtain the Organization ID, the organization must undergo an “Eligibility Verification” process. If the organization meets the ANCC requirements for eligibility an Organization ID will be issued and displayed on the headings of all the following pages. PLEASE RETAIN THIS ORGANIZATION ID FOR YOUR FILES as it will be necessary to start, continue, edit, retrieve, or view any submitted application. If the organization does not meet the eligibility requirements the application will stop and the applicant will be advised to discuss the issue with the ANA Massachusets Approver Unit Peer Nurse Review Leader.

Step Two: EDUCATIONAL PLANNING

The application is a reflection of the educational planning process you have used to develop a quality continuing education program for nurses. Documentation of this process should be undertaken using the following ANA Massachusets Approver Unit Approved forms and uploaded into the application at the appropriate time. The forms should be completed before beginning the application, named in such a way that you will be able to locate it and upload (attach) it to the application.

Step Three: CONFLICT OF INTEREST

“Conflict of Interest exists when an individual is in a position to control or influence the content of an education activity and has a financial relationship with a commercial interest organization the products or services of which are pertinent to the content of the educational activity.”
The Nurse Planner must evaluate all individuals who are in a position to control or influence the content of an activity for conflict of interest. The Nurse Planner must also be evaluated for conflict of interest and this can be done by anyone on the planning committee.
There must be at least two people --one Nurse Planner and one other planner to plan each educational activity. The Nurse Planner is a currently licensed Registered Nurse who is knowledgeable of the CNE process and is responsible for adherence to the ANCC criteria AND must hold a baccalaureate degree or higher in nursing (or International Equivalent CGFNS) AND be actively involved in planning, implementing and evaluating this continuing education activity. One planner needs to have appropriate subject matter expertise for the educational activity being offered (Content Expert) and can also be the Nurse Planner or a Presenter who is on the Planning Committee. There also needs to be a person to review the nurse planner for conflict of interest. The individual(s) who fulfill the roles of Nurse Planner (NP), Content Expert and Reviewer of the Nurse Planner for COI must be identified.


Step Four: DISCLOSURE TO PARTICIPANTS

     1. Requirements necessary to obtain contact hours
     2. Official approval statement
     3. Presence or absence of conflict of interest
         Resolution of this conflict if one exists

In addition the following items must be provided if applicable:
If commercial support has been provided it is necessary to state this and identify the party providing the support
If it is a joint-provided program it must be clear who is the provider and who is the joint provider
The expiration date must be disclosed if it is an enduring or blended activity.

In order to complete your application you will need the following documents: (the links provide various formats, select the one best suited for your computer click on document type to download)


Conflict of Interest Forms (COI) for any person the Nurse Planner identifies as having a conflict of interest.
CoI Forms:     [MSWordTemplate:]    [OpenDocument:]   [PDFExample:]

The Planning Table:    [MSWordTemplate:]   [OpenDocument:]   [PDFExample:]

  
Certificate Templates:   [MSWordTemplate:]    [OpenDocument:]   [PDFExample:]


Joint-provider agreement (signed and outlining roles and responsibilities)


Electronic copies of any advertisement used (scanned or document)


Copy of completed certificate of completion (scanned or document)


Copy of all applicable disclosures (scanned or document)


It is recommended that you have these completed prior to beginning the application to make your on-line experience go more smoothly.



Additional information and helpful hints:

Information buttons can be found throughout the application. These have additional instructions for the related section, and provide guidance and clarification.

To move backwards in the application use the back arrows at the top of the page. If you get a error message click the back arrow a second time.


If you have moved back to the lists of planning committee members or presenters and it appears blank, refresh the list using the refresh button below the list


It is recommended that you print your application and keep it in a secure file. You are responsible for maintaining educational records in a secure, accessible and retrievable manner.


To submit the entire application document, it must be signed by the nurse planner (using the nurse planner signature code). This will be found on the sign and commit page at the end.


Thank you for choosing to submit your program for review by ANA Massachusets Approver Unit peer reviewers for contact hour credits.