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CAPE Notification of Coursework Form

Providers must submit information at least 30 days in advance of each new course offering. Failure to submit this form in a timely manner may jeopardize the provider’s accreditation status.

*NOTE: In the event that multiple CE courses are offered together (i.e. multi-program and/or multiday symposium), separate Notification of Coursework Forms are to be completed.

California Accreditation for Pharmacy Education
UC San Diego SSPPS CAPE Provider #209
Contact us at (858) 822-5590 or email: pharmacy@ucsd.edu


Email Address:


Contact Person for Event:

Title of Course:

Speaker's Name and Professional Designation:

Target Audience

Number of Hours to be Awarded for Course

Program Fee to be charged? (If yes, specify amount):
Yes
No

If Yes, please Specify Amount:

Event Information

Program Format:
Live Event
Independent Study

Live Event Date

Start Date / Time

End Date / Time

Live Event Facility Name:


Live Event Facility Address


Independent Study Made First Available

Date / Time:


Website or Location of Independent Study


Additional Instructions or Comments