Accreditation of EUREPA - Further Educational Courses

1.	Organizer: e-mail address: Fax number:
2.	Title of the course: (also framework of the course, if applicable)
3.	Place of the course:
4.	Date of the course:
5.	Name of EUREPA trainer(s):
6.	Specification of target group with expected previous knowledge of participant:
7.	What is the participant expected to know and to transform into his/her professional practice after attendance of this course?
8.	Within the framework of the European Certification in Epileptology for Medical Doctors, this course is part of the core curriculum   and / or   elective ( see "European Certification in Epileptology" )
9.	Form of course: (lecture, seminar, small group work included?, etc.)
10.	Number of participants expected:
11.	Teaching methods to be used:
12.	Techniques of presentation to be used:
13.	Educational material to be used             (EUREPA approval needed?):   yes   no
14.	Programme: already submitted will be submitted on: by e-mail to office@epilepsy-academy.org If it is an industry-sponsored course, the promotional part of the programme must be clearly identified ( see "Rules" ).
15.	Hand-out: planned, will be sent to EUREPA after edition not planned
16.	Specification of evaluation system: The evaluation form must include the question: “Was this course too promotional? Yes/No. If yes, please provide details:...”( see "Rules" ). The results must be submitted to the Eurepa secretariat within 6 weeks after the course.
17.	Financing: