CM Partnership Single Event Activity Form

Title of event(Required)

Location of event (City)(Required)

State(Required)

Date of event(Required)

Time event begins(Required)

:

Time event ends(Required)

:

Number of CM applied for(Required)

Please enter a number from 0 to 50.

Are you applying for(Required)

Select all that apply

Ethics Credits

Law Credits

Standard CM

Point of contact (Name)(Required)

First Last

Point of contact (Organization)

Point of contact (Title)

Point of contact (Email)(Required)

Point of contact (Phone)(Required)

Objective of the event and benefit for GPA Members(Required)

Projected attendance and audience(Required)

Event’s relevance to the planning community(Required)

Description of budget for the event(Required)

Anticipated role of GPA, including any monetary contribution requested(Required)

Acknowelgement(Required)

I Acknowledge that all publicity, handouts, other materials will include recognition of the Georgia Chapter as a partner/co-host and that point of contact commits to distributing sign-in sheets and session evaluation forms

Description of the Event/Sessions(Required)

Description of how the session meets the criteria below(Required)

APA Certification Maintenance (CM) Criteria:

- are designed to meet a specific planning-related training objective.

- are led by one or more experts on the subject. An expert is a professional who has made a contribution to the profession through practice, teaching, research or publications; completed works that proclaim individuality and mastery of the principles of planning taught; and whose work demonstrates outstanding quality and professionalism.

- are designed to teach subject matter appropriate in depth and scope and at a level beyond a planner with at least two years of professional planning experience.

- are non promotional in nature.

- address demonstrated educational needs.

- communicate a clearly identified educational purpose or objective.

- use learning methodologies and formats that are appropriate to the activity's educational purpose or objectives.

- use evaluation mechanisms to assess an activity's quality and relevance.

For more information on APA CM criteria, please visit www.planning.org.

Moderator's name(Required)

First Last

Moderator's organization

Moderator's title

Moderator's email(Required)

Moderator's phone(Required)

Moderator's relevant & notable achievements

1: Speaker's name

First Last

1: Speaker's organization

1: Speaker's title

1: Speaker's email

1: Speaker's phone

1: Speaker's relevant & notable achievements

2: Speaker's name

First Last

2: Speaker's organization

2: Speaker's title

2: Speaker's email

2: Speaker's phone

2: Speaker's relevant & notable achievements

Phone

This field is for validation purposes and should be left unchanged.

CM Partnership Activity Form

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