Forms

Please use the forms below to submit requests to the Center for Professional Practice of Nursing.

Please use these forms to register for a class or submit a waiting list request.

• Registration Request Form (PDF)
• Waiting List Request Form (PDF)

Please use these forms to plan a continuing education course or request material. Continuing education course planning forms will only be approved when the biographical data and conflict of interest forms for all planning committee members and presenters are submitted with the course planning form. If you need assistance in completing the form, or wish to consult with an educator concerning your course, please contact Sabrina McKinney at smckinney@ucdavis.edu.

To request approval for a continuing education course:

1. Download the Continuing Education Course Planning Form (Word)
2. Download the Biographical and Conflict of Interest Form (Word)
3. Send the completed course planning form, course agenda, and biographical data and conflict of interest forms for all planning committee members and presenters as an e-mail attachment to hs-cppn@ucdavis.edu. We will not accept handwritten or faxed applications.
4. Note new requirement: the California Board of Registered Nursing (BRN) now requires that all continuing education courses that contain any direct patient care component must include curriculum on implicit bias. CPPN cannot provide CE credit for courses that fail to meet this requirement. Please review the course planning form and the Incorporating Implicit Bias into Continuing Education Curriculum (PDF) resource for more information.

Gap analysis tool for planning continuing professional development
A gap analysis is an important tool during the beginning of an educational plan to take you from “I think I know what the problem is” to planning relevant professional development activities targeted to specifically address a clearly established professional practice gap, resulting in measurable outcomes. Analyzing a professional practice gap determines the gap between a current and desired state, underlying educational need(s), and activities needed to close the identified gap. This form is part of the Continuing Education Course Planning Form.

• Gap Analysis Tool for Planning Continuing Professional Development (PDF)

Request for additional class dates for previously awarded continuing education course
Please use the form below to request class material for previously approved courses.

• Previously Awarded Continuing Education Course Request for Additional Dates Form (Word)

Please use these forms to plan a continuing education course to provide Approved Continuing Education for Licensed Clinical Social Workers. Continuing education course planning forms will only be approved when all the required materials are submitted with the course planning form. If you need assistance in completing the form, or wish to consult with an educator concerning your course, please contact Sabrina McKinney at smckinney@ucdavis.edu.

To request approval for a continuing education course:

• Download the Continuing Education Course Planning Form - ACE for LCSWs (Word)
• Download and review the Instructions Sheet - Approved Continuing Education for LCSWs (PDF)
• Download the Biographical and Conflict of Interest Form (Word)
• Send the following as e-mail attachments to hs-cppn@ucdavis.edu:
  • (1) completed Social Work CE Course Planning Form, (2) course agenda, (3) all course materials (including presentations, handouts, and pilot testing and post-tests if used), (4) course bibliography/reference list, (5) all promotional materials, (6) resumes/CVs for all instructors/presenters, (7) proof of licensure for all instructors/presenters, and (8) biographical/conflict of interest forms for all instructors/presenters and planning committee members, including a brief bio for promotional materials. We will not accept handwritten or faxed applications.

Virtual education is vital for current times. In this sway, the best practices for virtual education will be highlighted. Recommendations for synchronous, asynchronous, and a blend of both synchronous/asynchronous sessions will be reviewed.

• Best Practices for Virtual Education (staff only; requires UC Davis Login [Kerberos]). 

Please use this form to request an activity code and roster for non-C.E. activities which will be used to enter records into UC Learning Center training transcripts.

• Non-C.E. Course Request Form (Word)

This form is used when submitting an eLearning to be made available in UC Learning Center. More information on the UC Learning Center Resources & Support page.

• eLearning Submission Form (Word)

This form is used when submitting a microlearning educational session to be made into a QR code. More information on the Policies page.

• QR Code Microlearning Submission Form (PDF)