Transfer of Provider Units

Please complete this form and pay the $225 transfer fee to move your provider units to the Colorado Nurses Association. (After the first year of approval, your organization will be charged a $100 annual renewal/maintenance fee.)

Date of this application

Name of Organization

Address

Apt, suite, etc.

Country

City

State

Zip code

Primary Nurse Planner Name and Credentials

Primary Nurse Planner Title

Phone

States in which licensed as an RN

Nursing License Number(s)

Please Provide the Name of Previous Approver Agency

When does your current approcal expire?

Upload copy of approval letter from most recent approval agency

Does your provider unit have a website that publicly addresses your nursing continuing professional development (NCPD) activities?

Yes

Is your provider unit part of a multi-focused organization (an organization that provides more services than nursing continuing professional development)?

Yes

Upload your most recent self study application

Upload one recent Individual Activity File that demonstrates your implementation of most recent relevant financial relationship adherence

Upload a certificate with Colorado Nurses Association approval in the format below:

{Name of Approved Provider} is approved as a provider of nursing continuing professional development by Colorado Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.

Please upload your most most recent eligibility form

Can you confirm nothing has changed that would make you ineligible

Yes

Approved Provider Responsibilities

Responsibilities of approved providers include:

Maintain adherence to all applicable federal, state, and local laws and regulations that affect the provider unit’s ability to meet CNA criteria
Identify a Primary Nurse Planner who has overall responsibility for the approved provider’s adherence to ANCC accreditation criteria, including orientation of other nurse planners and key personnel
Ensure that a qualified nurse planner is an active participant in the planning, implementation, and evaluation of each educational activity (the nurse planner must be a currently licensed RN with a baccalaureate degree or higher in nursing)
Ensure that each learning activity planning committee has a minimum of a qualified nurse planner and one other person to plan each activity – the nurse planner to ensures adherence to criteria, and at least one person with subject matter expertise related to the activity
Ensure that the nurse planner is responsible and accountable to review and evaluate actual or potential Relevant Financial Relationship for each planning committee member, faculty, presenter, author, content reviewer and anyone else who has influence or control over the content of the learning activity.
Notifying CNA in writing, within 7 business days, of the discovery or occurrence of the following:
- Significant changes or events that impair the ability to meet CNA nursing continuing professional development requirements or affect eligibility to remain an approved provider, including change in commercial interest status
- Loss of status as a C/SNA of ANA
- Any event that might result in adverse media coverage related to the delivery of continuing nursing education
Notifying CNA in writing, within 30 days, of any changes within the approved provider organization, including but not limited to:
- Changes that alter the information provided in the approved provider application, including change of name, address, or business status
- A decision not to submit a provider application after completing the eligibility/intent to apply form
- Change in Primary Nurse Planner or suspension, lapse, revocation, or termination of the Primary Nurse Planner’s registered nurse license
- Change in nurse planners or suspension, lapse, revocation, or termination of any of the nurse planners’ registered nurse licenses
- Change in ownership
- Indication of instability (e.g. labor strike, reduction in force, bankruptcy) that may impact the organization’s ability to function as an approved provider

Colorado Nurses Association is accredited as an approver of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

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