CM Partnership Single Event Activity Form

Title of event*

Location of event (City)*

State*

Date of event*

Time event begins*

:

Time event ends*

:

Number of CM applied for*

Please enter a number from 0 to 50.

Are you applying for*

Select all that apply

Ethics Credits

Law Credits

Standard CM

Point of contact (Name)*

First Last

Point of contact (Organization)

Point of contact (Title)

Point of contact (Email)*

Point of contact (Phone)*

Objective of the event and benefit for GPA Members*

Projected attendance and audience*

Event’s relevance to the planning community*

Description of budget for the event*

Anticipated role of GPA, including any monetary contribution requested*

Acknowelgement*

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*

Description of how the session meets the criteria below*

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*

First Last

Moderator's organization

Moderator's title

Moderator's email*

Moderator's phone*

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

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