Iowa Geriatric Education Center Iowa Geriatric Education Center

Geriatric Lecture Series Forms

See the "About the Geriatric Lecture Series" page for information on how to register for the series.

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.

 Get Acrobat Reader 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 PHYSICIANS/PHYSICIAN ASSISTANTS: Each participating physician/physician assistant who wants CME credit MUST fill in this application form. This form does NOT serve as documentation of viewing an individual lecture.

CEU Application Form
For NURSES/NURSE PRACTITIONERS: Each participating nurse/nurse practitioner who wants CEU credit MUST fill in this application form. This form does NOT serve as documentation of viewing an individual lecture.

Participation Application Form
For OTHER DISCIPLINES: Participants from all other disciplines (e.g., social work, physical therapy, long-term care administration, etc.) who want a certificate of participation MUST fill in this application form. This form does NOT serve as documentation of viewing an individual lecture. Nurses and physicians, see above for your specific forms.

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