Individual Activity Applicant's Name
Educational Planning Table – Enduring (2013 criteria)
AA/IA-ED Plan
Title of Activity: ________________________________________________________________________________________________
Identified Gap(s): ________________________________________________________________________________________________
Description of current state:________________________________________________________________________________________
Description of desired/achievable state: ______________________________________________________________________________
Gap to be addressed by this activity:
Knowledge
Skills
Practice
Other: (Describe)_______________
Purpose: (write as an outcome statement, e.g. "The purpose of this activity is to enable the RN to ______________________________
________________________________________________________________________________________________________________
CONTENT
TILE OF PRESENTATION
AND OBJECTIVES
List learner’s objectives in
behavioral terms – The RN will be
able to….
(Topics)
AUTHOR
Provide an outline of the content for each objective.
It must be more than a restatement of the objective.
List the author for each
objective
INSTRUCTIONAL
STRATEGIES USED
List the methods &
instructional strategies used
by
Faculty/Presenters/Authors to
cover each objective.
1.
2.
Rev. 01/2014
Individual Activity Applicant Educational Planning Table 2013 – Live
Page 1 of 2
Individual Activity Applicant's Name
Educational Planning Table – Enduring (2013 criteria)
AA/IA-ED Plan
3.
List the evidence-based references used for developing this educational activity:
Additional rows may be added as needed.
Method of calculating contact hours:
Pilot Study
Historical Data
Complexity of Content
Other: Describe______________________________
Estimated Number of Contact Hours to be awarded: __________
______________________________________________________
Completed By: Name and Credentials
Rev. 01/2014
__________________________________
Date
Individual Activity Applicant Educational Planning Table 2013 – Live
Page 2 of 2