Get Vendor Education Request Form Please Print Clearly ...

The Vendor Education Request Form is an essential document for individuals seeking to present educational programs at designated locations. This guide will help you navigate the form step-by-step to ensure that all necessary information is accurately provided.

Follow the steps to fill out the Vendor Education Request Form online.

1. Press the ‘Get Form’ button to access the Vendor Education Request Form and open it in your chosen editor.
2. Clearly print your name in the 'Name of Individual Requestor' field to identify yourself as the requestor.
3. Enter the 'Date of Request' to indicate when you are submitting the form.
4. Fill in your 'Company' name to specify the organization you represent.
5. Provide your 'Telephone Number' and 'Email Address' for communication purposes.
6. Select the 'Location Where Program is to be Presented' from the provided options.
7. Choose a 'Name of Contact Representing Location' from the list to ensure proper communication.
8. Specify your 'Requested Date of Presentation' ensuring that it is at least two weeks after the date of submission.
9. If needed, provide an 'Alternate Date' as a backup option for your presentation.
10. Indicate the date of your 'Last Presentation at this Location', noting the restrictions on frequency.
11. Write the 'Name of Presenter' who will deliver the educational content.
12. Check the intended audience for this program, selecting from Physicians, NP/PA, or Support Staff.
13. If applicable, explain why the program is intended for support staff.
14. Determine the 'Length of Program' ensuring it does not exceed 60 minutes.
15. Indicate whether 'Lunch Provided' with a simple yes or no.
16. List any products or services your company currently provides to APM/MAPS/APS.
17. Clarify if you or the presenter is an immediate family member of any APM/MAPS/APS provider or staff member.
18. If answered yes to the previous question, identify that individual.
19. Describe the purpose of the program and the nature of the educational content, noting any updates.
20. Attach copies of the slides or educational materials that will be presented, as they are required for approval.
21. Sign the 'Representative Attestation' confirming the purpose and compliance with policies.
22. Ensure you include your signature (note that electronic signatures are not accepted) and the date.
23. Once all fields are completed and reviewed for clarity, save your changes, and share, download, or print the completed form.

Complete your form now and submit it online for review.