Directory  |  Calendar  |  Forms  |  Contact Us  |  Login

Application for IHS Continuing Education Course Approval

Contact and Billing Information
First Name: *
Last Name: *
Job Title: *
Company: *
Street Address: *
Street Address (2):
City: *
State/Province: *
Zip/Postal Code: *
Phone: *
Fax:
E-mail: *
   
Course Information
Education Provider
(Organization Name): *
Course Title: *
Number of CE Credits requested: *
IHS awards one (1) continuing education credit for every sixty (60) minutes of instruction. Thirty (30) minutes are equivalent to .5 credits. (e.g. 60 minutes = 1 credit, 90 minutes = 1.5 credits)

Course Format: Check only one:
*
One topic one-day event
One topic multi-day event
Multi-topic one-day event
Multi-topic multi-day event
Online (web-based / e-learning)
Self-Study
Other (Please describe):


Target Audience: *
The target audience for this course is a hearing healthcare professional who dispensing hearing instruments?
Yes No Other (Please explain):
This course will be offered to the public.
This course is for invited participants only. Please do not publicize this course in The Hearing Professional magazine or on the IHS website.

Level: *
Beginner Advanced Other (Please explain):

Date Course will be held: *
If you will offer the same course on numerous dates or in multiple locations, please indicate the date range. Only apply once for a course being offered on numerous dates or in multiple locations.
Start Date: *
End Date: *

Course Location: *
If you will offer the same course on numerous dates or in multiple locations, you only need to apply once for the course.

Check if this course will be offered in multiple locations.
Facility Name where course is being hosted: *
City: *
State:

Course Description: *


Learning Objectives: *
Learning Objectives should focus on the anticipated learner outcomes. For Example: "By attending the course, you will learn how to _____________________"
1. 
2. 
3. 
4. 
5. 
6. 
7. 
8. 
9. 
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.


Categories of Instruction: *
Check all that apply. Click here for a detailed list of the IHS Approved Categories of Instruction

CATEGORY I – Hearing Science
CATEGORY II – Audiometric Assessment
CATEGORY III - Audiometric Interpretation
CATEGORY IV - Patient Information and History
CATEGORY V – Hearing Instrument Systems Technology
CATEGORY VI - Earmold Impressions
CATEGORY VII – Selecting Amplification Systems
CATEGORY VIII – Instrument Fitting Techniques
CATEGORY IX – Patient Follow-up Care
CATEGORY X - Management Considerations in Instrument Dispensing
Other (Please describe):

Instruction Method: *

Lecture
Open discussion
Practicum or Hands-on Instruction
Case study
Online presentation with instructor (webinar)
Video audio or online pre-recorded presentation (self-study)
Other (Please describe):

Time-ordered Agenda: *
Provide a time-ordered agenda of the course including the time, by topic, description and instructor. To add more agenda fields, click the “Insert More Agenda” button below. Add a new agenda item for each topic in the course. IHS does not require the speaker’s biography for approval.
Agenda 1
Start Time (XX:XX am) End Time (XX:XX am) Topic
Instructor Instructor Job Title Instructor Company
Topic Description


Agenda 2
Start Time (XX:XX am) End Time (XX:XX am) Topic
 
Instructor Instructor Job Title Instructor Company
Topic Description


Agenda 3
Start Time (XX:XX am) End Time (XX:XX am) Topic
 
Instructor Instructor Job Title Instructor Company
Topic Description


Agenda 4
Start Time (XX:XX am) End Time (XX:XX am) Topic
 
Instructor Instructor Job Title Instructor Company
Topic Description


Agenda 5
Start Time (XX:XX am) End Time (XX:XX am) Topic
 
Instructor Instructor Job Title Instructor Company
Topic Description


Agenda 6
Start Time (XX:XX am) End Time (XX:XX am) Topic
 
Instructor Instructor Job Title Instructor Company
Topic Description


Agenda 7
Start Time (XX:XX am) End Time (XX:XX am) Topic
 
Instructor Instructor Job Title Instructor Company
Topic Description


Agenda 8
Start Time (XX:XX am) End Time (XX:XX am) Topic
 
Instructor Instructor Job Title Instructor Company
Topic Description


Agenda 9
Start Time (XX:XX am) End Time (XX:XX am) Topic
 
Instructor Instructor Job Title Instructor Company
Topic Description


Agenda 10
Start Time (XX:XX am) End Time (XX:XX am) Topic
 
Instructor Instructor Job Title Instructor Company
Topic Description




Assessment: *
Select what method you will use to assess if the learning objectives were met. Check all that apply.

Exam / Quiz / Test
Performance demonstration
Written report
Completion of a project
Self-assessment
Question and answer session
Other (Please describe):


Payment
To expedite processing of your application, please provide a credit card to pay the course approval application fee. Once the course is approved, the card will be charged. IHS will send you an email message with a confirmation letter and a receipt.

Payment Method
Choose your method of payment Visa MasterCard American Express Discover
Name on Card
Card Number
Expiration Date
Security Code

If you are unable to pay by credit card, an invoice will be provided after the course is approved.

If you have any supporting documents to accompany this application, please email the documentation directly to education@ihsinfo.org.




For questions regarding IHS course approval email education@ihsinfo.org.