Education & Research

Intake Form

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Request for Proposal of New Education Activity

The Foundation welcomes ideas for new continuing education activities. Please complete this form if you would like to propose a new activity. You are not required to be a member of the Academy.

A downloadable/printable version of this form is also available.

Name.
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1. Committee (when appropriate):
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2. Academy Staff Liaison (when appropriate)
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3. Provide a specific title or course topic for proposed activity.
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4. Please provide a short abstract of the proposed course.
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5. Describe the educational objective(s) of the activity.
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6. Why is there a need for this activity? (Please be specific)
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7. Who is the intended audience? (Otolaryngologists/Residents/Allied Health/Other):
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8. How will this activity improve patient care/outcomes?
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9. Who will author this activity (please include your name and email address if you would like to volunteer)?
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10. Use this space for additional comments. Additional documents can be sent to ce@entnet.org.
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American Academy of Otolaryngology — Head and Neck Surgery

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Phone: 1-703-836-4444