Are you interested in offering a course at Boston University Henry M. Goldman School of Dental Medicine?

Thank you for your interest in developing a new course to be presented through Continued Education.

Contact Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Course Information

Course Title(Required)

Description(Required)

Objectives(Required)

Brief Course Schedule(Required)

A typical course will sign in at 8:30am and begin at 9am. Breaks are given mid-morning and mid-afternoon, with lunch served at ~12:00pm.

Number of Hours (CEU)(Required)

Not including lunch or breaks

Educational Methodology(Required)

Check all that apply

Lecture

Lecture/ Hands-on,Workshop

Clinic

Live Patient

Other

Hands-On Course Supplies and Materials*(Required)

Continuing Dental Education will provide… Sponsors will provide… Participants will provide…

*May be NA for lecture courses.

Financial

Provide estimates in $USD(Required)

Proposed Speaker Honorarium Proposed Participant Fee

Honorarium is inclusive of travel. NOTE: Actual honoraria will be determined by final budget based on projected enrollment and expenses and is subject to approval by the Office of Continuing Dental Education.

CE Verification

ADA CERP Standards Require us to ensure scientific basis for the clinical and technical CE content in each course. To help us comply with this Standard, please respond to the statement below.(Required)

"I verify my presentation is based on scientific evidence and will present such evidence in my presentation"

After completing this form, if you have any more questions, contact Joanne Kayden, Business Manager, jklow@bu.edu, 617-358-0993.