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CPE Activity Form - Co Sponsored
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Please complete the following for your planned Continuing Pharmacy Education activity.



Please provide the following information about the Faculty (presenter/speaker).
Please complete the following information about the financial support for this activity.
Please indicate the following in planning this activity.


Please select ONE of the following activity types.


Please develop 3-5 appropriate learning objectives for the indicated audience. Objectives should be S.M.A.R.T (Specific, Measurable, Attainable, Results-Focused, Time-Focused).

If the target audience includes Pharmacists and Pharmacy Technicians, each must have SEPARATE AND DISTINCT objectives, specific to their respective roles in Pharmacy.
Please complete the following relative to after the completion of the activity.
P.L.A.N. is a CPE information service provided online through ACPE, allowing LPA to include listings of activities for all pharmacists and pharmacy technicians to search for CPE activities, both live and home-study.


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