Application for Approval of Educational Events for CPD
Applications will not be considered unless all fields below are completed and all supporting documents are included in the application package
Title of Event: this can not contain a sponsor or product name
Date(s) of Event:
Venue(s):
if the event is online, enter relevant url and access details
Duration of Education Sessions
(not including registration, opening/closing speeches, breaks etc)
Relevant Medical Specialty:
Venue Location(s):
Your event should be predominantly aimed at post-training doctors,
and fall under the External (Maintenance of Knowledge and Skills)
category. Please enter the target medical specialty(ies) below. Do not
enter roles or post-types.
Medical Organiser:
Event Administrator:
The Medical Organiser of this event assumes responsibility for
ensuring the scientific validity and objectivity of the educational
content. He or she must personally complete the Medical Organiser
Declaration. The Medical Organiser cannot be an employee of an
Industry Sponsor
The Event Administrator is the person responsible for contacting
delegates, registration, and issuing of CPD attendance certificates
following the event.
Name
Name
Medical Council or
Professional Body
and Registration
Number
Position*
Organisation
Organisation
Phone/Mobile
Phone/Mobile
Email
Email
What are the objectives of the event?
What specific skills/knowledge will participants acquire during the event?
Which teaching methods will be used?
Lectures
Workshops



Individual Performance Review

Discussion Groups

Tutorials
 

Demonstrations
MCQs

Practicals


Quizzes



Other: (Please Specify):
Which of the Medical Council’s 8 Domains of Good Professional Practice are addressed in the educational
activity? (Please tick the domain(s) applicable)
Patient safety & quality
of patient care
Management (including
self management)
Communication &
Collaboration & teamwork
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Relating to patients
Professionalism
Scholarship
Clinical skills
The Royal College of Physicians of Ireland Application for Approval for CPD Accreditation
interpersonal skills
Is sponsorship sourced from a commercial organisation? (Tick One)
Event is
not
sponsored
Single
Sponsor
organising
event 
Multiple Sponsors

Unrestricted
Educational grant
Main Sponsor:
Main
Sponsor
Contact
Name:
List all sponsors and how they are connected to the event:
What is the total value of the sponsorship?
Please describe the relationship between the sponsor(s) and the speaker(s)
Demonstration of Academic Independence
Industry sponsors must also provide the additional information listed in the Industry Sponsor section of our Guide to CPD Approval
The learning component of this event is unbiased
Tick = Yes
Blank = No
Display tables/material related to sponsor or sponsor’s products will not be placed in the education area (lecture
theatre or room where educational content is delivered)


Educational programme and materials including slides, abstracts and handouts do not contain any advertising, trade or
corporate message or logo

Meeting title and programme titles do not contain or refer to the sponsor or any product


The sponsorship arrangements for this event are compliant with the guidelines of the Irish Pharmaceutical Healthcare
Association and/or the Code of Ethics on Interactions with Healthcare Professionals(Medical Devices)
Application Assessment Fee
(a) Event organised and/or hosted by a single commercial sponsor (pharmaceutical or medical device company)
€1,500
(b) Event organised and/or hosted by a professional commercial education provider
€1,500
(c) Event with multiple industry sponsors
€500
Applications for an event supported by multiple industry sponsors may not be submitted by an industry sponsors
(d) Event supported by an unrestricted educational grant
€500
Applications for an event supported by an unrestricted educational grant may not be submitted by an industry
sponsors
(e) Unsponsored event with registration fee
(f) Unsponsored event no registration fee
€250
No Charge
An explanatory letter from the organiser must accompany such applications
The assessment fee is non-refundable
Payment Details
Cheque:
Please staple the cheque to this form
EFT:
contact us to request a reference number before submitting an electronic fund transfer
Invoice:
contact us to request an invoice before you submit your application.
Purchase Order:
contact us to request a reference number before submitting a purchase order
Credit Card Details
Card Number
Expiry Date
Card Type (Visa or Mastercard only)
Amount:
Cardholder:
Submit this form and supporting documents at least four weeks before you intend to circulate invitations
to your event
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Professional Competence Department, Royal College of Physicians of Ireland
Frederick House, 19 South Frederick Street, Dublin 2, Email: professionalcompetence@rcpi.ie