Submit your Faculty Agreement! Joint Providership

MPhA CPE Faculty Agreement- Joint Providership

Please complete this faculty agreement to confirm your participation and compliance with MPhA’s accreditation requirements for educational activities for pharmacists and technicians.

MPhA Online Faculty Agreement- Joint Providership

Welcome to MPhA’s online faculty agreement! Please review and complete each section, confirming that all information provided is accurate and agreeing to the outlined terms. Unless otherwise stated, all MPhA education is usually accredited for both pharmacists and technicians.

Contact Information

Your Name(Required)
Address(Required)
Credentials(Required)
Select all that apply.
Please include a short bio, limited to no more than 6 sentences, highlighting your professional background and expertise.
Max. file size: 256 MB.

Activity Information

Please provide a brief description of this learning activity.
In this section, please explain the rationale for the proposed activity. Include details about the specific knowledge gaps or issues within the target audience that this activity aims to address.
Activity Setting(Required)
Example: 1 hour 30 minutes
Please list the learning objectives for this activity. Learning Objectives may be similar for both pharmacists and technicians. Use Bloom’s Taxonomy as a reference to craft your learning objectives. This is located on MPhA’s CPE Resource Page. There should be at least three objectives for a CPE activity.
Please select the most applicable ACPE Topic Designator for this activity.(Required)
As the ACPE-accredited provider of continuing pharmacy education, MPhA retains the right to change the topic designator if necessary.

Financial Relationship Disclosures

As the speaker and in control of the content, this section is for you to disclose any relevant financial relationships with any ineligible entities (ineligible entities are companies that sell/market or distribute products to be used on or by patients) within the past 24 months. This would include any consulting fees charged, honoraria, stock ownership, or other forms of compensation. If you have no disclosures, please skip this section and check off the certification field below. If you have more than one financial relationship to disclose, please notify the hosting organization.
Disclosure Acknowledgment:(Required)

Certification and Signature

I certify that all media materials, including but not limited to handouts and presentation slides are of original content and not subject to copyright release by another party. If all or a portion of media materials include information from copyrighted sources, the presenter agrees to provide appropriate evidence of copyright release and agrees to reference such sources in the media materials. I agree to hold MPhA harmless from any action which may result from my use of materials, permission for which has not been appropriately obtained from the holder of a copyright, and/or which are not appropriately referenced.
By typing your full name, you confirm that the information provided in this agreement is accurate and that you agree to the terms and conditions provided above.