Geriatric Lecture Series Forms

In order to receive CME or CEU credit for viewing the Geriatric Lecture Series, participants need to complete an attendance form, an application form, and an evaluation questionnaire. The attendance form must be completed for each presentation viewed. The CME or CEU application only needs to be completed once for the series. Please complete an evaluation for each presentation viewed.

Please note: if you are viewing the presentation as an individual, you will be able to complete the attendance sign-in form and evaluation questionnaire electronically at the end of the presentation and submit them to our database. If you do this, you do not need to complete paper copies of these two forms.

To view and print these forms, click on the links below. The forms require Acrobat Reader, a free download from Adobe Systems. Click on the logo if you do not already have Acrobat Reader.

Presentation Handouts
For ALL Participants: Each participant may download a copy of the handouts to use during the upcoming GLS presentation.

Attendance Sign-In Sheet
For GROUP Viewing: Each participant who wants continuing education credit MUST sign one of these attendance sheets.

CME Evaluation Questionnaire
For GROUP Viewing: Each participating physician is asked to complete a CME evaluation questionnaire for each session attended.

CEU Evaluation Questionnaire
For GROUP Viewing: Each participating nurse/nurse practitioner is asked to complete a CEU evaluation questionnaire for each session attended. Participants from other disciplines are also asked to complete this evaluation.

CME Application Form
For ALL Participants: Each participating physician who wants CME credit MUST fill in this application form and questionnaire.

CEU Application Form
For ALL Participants: Each participating nurse who wants CEU credit MUST fill in this application form and questionnaire. Participants from other disciplines who want a certificate of participation should also complete this form.

For Group Viewing: Each Site Coordinator should collect all forms after the presentation and either:

Mail them to:
Iowa Geriatric Education Center
2153 Westlawn
Iowa City, IA 52242

Fax them to:
Iowa Geriatric Education Center
319-335-6785