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Activity Main Details

Contact Details of Applicant

Clinical Content Writer/Reviewer/Subject Matter Expert Details

Activity Sponsorship

Is the activity sponsored?*

Activity overview

If face-to-face, which state is the activity held in?

Geographical Area

Has this activity been recognised by any other organisations?

If yes, please select each of the following which apply:

Capabilities Covered in this Activity

Please tick all Lung Learning Capabilities that apply to your activity.*

Additional Activity Description

Audience

Who is your target audience?

Prerequisites

Activity Outline

Please use the following fields to provide activity-specific information around topics covered against each learning outcome and opportunities for interactivity. This will provide evidence of consideration for best practice adult learning principles in the design of your activity.

Declaration

Peer Review

Evidence Checklist