strengthening the veterinary

regulatory community

RACE Provider Application



* Indicates required field
Organization Name *
Address 1 *
Address 2
City *
State or Province Code *
ZIP/Postal Code *
Website
Contact Name
*
Prefix First Middle Last Suffix
Title
Phone *
Fax
E-mail *
Status
How long has this organization been in operation? *
How many CE programs has this organization offered? *
Other Approval Agencies
(List other agencies which this organization is approved or accredited for Continuing Education)
Other Denial Agencies
(List other agencies which have denied or removed approval or accreditation for Continuing Education for this organization)
Has this organization co-sponsored Continuing Education programs?
Check the types of CE credit your organization plans to award

Attendance Policy
(Describe Attendance Monitoring policy and method your organization will use for programs this organization provides)
Does you organization agree to comply with the Standards for Providers adopted by AAVSB?