Request for CEUs » Continuing Dental Education » College of Dentistry

College of Dentistry Departmental Request for CEU’s

The Office of Continuing Dental Education provides:

Review for ADA CERP compliance
Certificate printing
Distribution of CEU certificates to department or via participant email
Reporting CEUs to FL CE Broker & AGD
Maintain ADA CERP recognition
Maintain records for six years per ADA CERP standards

Upon comprehensive completion of the form, we will reach out to you for a meeting to further discuss your event.

Request must be submitted at least three months prior to course date.

Request for CEU

Office / Administrative Contact(Required)

Department

Name

Phone

Lecture Type(Required)

Single Speaker: one speaker / one lecture title

Symposium or Lecture Series: multiple speakers / lecture titles

Single Speaker

Course Information(Required)

Lecture Date

Location

Speaker Information(Required)

Name

Phone

Credentials (CV & Short Biosketch)(Required)

Drop files here or

Max. file size: 125 MB.

Course Title(Required)

Course Description(Required)

Course Objectives(Required)

List at least 3 learning objectives

Brief Course Schedule/ Agenda(Required)

Symposium or Lecture Series

Information(Required)

Proposed Date(s)

Location(s)

May be a general date range: Fall 2023-Spring 2024

Speakers & Lectures(Required)

Speaker Name

Lecture Title

Include all speaker names, emails and lecture titles.

Lecture Descriptions(Required)

List a short paragraph description for each lecture title

Lecture Objectives(Required)

List at least 3 learning objectives for each lecture title

Schedule(Required)

Attach All Speakers Credentials (CV & Short Biosketch)(Required)

Drop files here or

Max. file size: 125 MB.

Department Billing Information

Provide the chartfield string to which the fee can be billed

Chartfield String(Required)

Dept.

Fund

Program

Flex

Is this being paid for by a Grant?(Required)

Yes

Grant Information(Required)

Grant #

Date Grant Funding Ends

CE Verification

Name

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