Ms. Gemma Collins

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Ms. Gemma Collins

Manor Farm Road, Little Haywood Staffordshire, Staffordshire ST18 ONV, United Kingdom

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IVCA Continuing Education Provider Application Form

Thank you for your interest in becoming an IVCA Approved Continuing Education Provider. Please complete the following application and submit it along with all required documentation at least 60 days prior to the proposed course date.

Provider Information

Name of Organization or Individual(Required)

Primary Contact Person(Required)

Email Address(Required)

Phone Number

Mailing Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Instructor Information

Course Title

Type of Course (e.g., in-person, webinar, on-demand)

Proposed Course Date(s)

Total Hours Requested for CE Credit

CE Category (check one or both)

Animal Chiropractic-Specific CE

General Veterinary or Chiropractic CE

2. Course Information

Name(s) of Instructor(s)

Attach current CV(s), relevant certifications, and documentation of education and experience.

Drop files here or

Max. file size: 512 MB.

4. Course Materials

Please attach the following with your application

Max. file size: 512 MB.

- Detailed course outline or syllabus
- Defined learning objectives and expected outcomes
- Sample teaching materials (if available)
- Conflict of interest disclosures

International Veterinary Chiropractic Association e.V. Bahrenfelder Strasse 201a 22765 Hamburg, Germany

+ 0049 151 646 88 741

contact@ivca.de

support@ivca.de

IVCA Continuing Education Provider Application Form

Provider Information

Instructor Information

2. Course Information

4. Course Materials

5. Declaration