Initial Application for Joint Providership

Complete this Initial Application for consideration of Joint Providership of a CME activity with the Massachusetts Medical Society (MMS).  A separate application is required for each activity.

Your application will be reviewed within 1-2 weeks of its receipt at MMS.  You may be contacted for additional information.  After review, you will be informed of the decision and, if accepted, the joint providership fee and associated accreditation responsibilities.

If in agreement, we will request that you complete the Activity Planning Document which begins the formal process of submitting an activity for review by the MMS Committee on Sponsored Programs.  The completed Activity Planning Document must be submitted to MMS at least 5-6 months prior to the start date of your activity.

Please direct any questions to mmscmecertification@mms.org. Please fill in the requested information in the boxes provided below.

Applicant Information:

1.  Name of organization* 

2.  Contact person* 

3.  Address* 

4.  Email* 

5.  Telephone number* 

Activity Information:

6.  Title of activity*   

7.  Activity format (i.e. live event, webinar, online course, home study)* 

8.  Date of live activity or launch date of online course* 

9.  If live activity, length of event (number of days) 

10.  If live activity, start and end times for each date   

11.  If live event, number of faculty members (including moderators, panelists, and facilitators) 

12.  Briefly describe the learning methods to be used (i.e., lecture, case study, panel discussion, breakout sessions, etc.)*   

13.  Number of commercial supporters expected to be contacted for financial support of the activity (if none, write 0)*   

14.  This activity promotes improvement or quality in health care and was planned free of commercial interest.*  

                                    

15.  What are the professional practice gaps that this activity will address?* 

16.  Give a brief (~200 words) general description of the planned activity.*   

17.  Why are you seeking joint providership with the MMS for this educational activity?* 

To submit your application, click on the "submit form" button below.  If you have any questions, contact the MMS Department of Continuing Education & Certification at mmscmecertification@mms.org or 800-322-2303, x7306. 

                                                                  

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