SPONSORSHIP DECLARATION FORM
Sponsorship is support (monetary or “in-kind”) furnished to the provider of the educational activity. When an educational activity is supported by more than one entity, each entity is a co-sponsor. Sponsors and co-sponsors do not participate in planning, developing and implementing the educational activity. Sponsorship must be acknowledged to the learners.
Commercial support, which is one type of sponsorship, is a financial or in-kind contribution (e.g., meals/snacks and supplies such as dressings to complete a skill-based program) given by a commercial interest (separate organization and not the providing organization) which is used to pay all or part of the costs of a continuing nursing education activity. A commercial interest is defined as an entity that produces, markets, sells or distributes healthcare goods or services consumed by or used on patients.
Education must be kept separate from promotional activities. Commercial support, exhibits or the presentation of research conducted by a commercial company, shall not influence the design and scientific objectivity of any educational activity. or Commercially-supplied funds for an educational activity that are given in the form of an educational grant or in-kind assistance shall be acknowledged in the brochures and/or printed material for the continuing education activity.
Important:
- Please review Appendix C in the INA criteria manual for the standards (definitions and conditions/stipulations) regarding commercial support.
- Per established policy,INA may not sign sponsorship agreements.
Reminder:
- A sponsor is not the providing organization of the educational activity. A sponsor is a different organization.
- Educational materials such as slides, abstracts and handouts must not contain any advertising, trade name or a product-group message.
The questions regarding sponsorship (e.g., commercial support) must be completed on this form.
- Will this educational activity receive sponsorship?
This educational activity has not received sponsorship
(Do not complete sections 2-6.)
This educational activity has received sponsorship
(Complete sections 2-6 below)
- Sponsorship has been provided by (list the name/s of the organization/s. (Add additional boxes if necessary):
Name of Organization
Name of Organization
- Is the sponsorship being provided by a commercial interestwhich is defined as an entity that produces, markets, sells or distributes healthcare goods or services consumed by or used on patients? (Type an X in only one of the white fields below.)
Yes
No
4. Content integrity will be maintained for the CNE activity since it is receiving sponsorship as
follows: (Type an X in the white area for all that apply)
Our sponsorship policy/procedure has been discussed with those providing sponsorship.
Our sponsorship policy/procedure has been shared in writing with those providing sponsorship.
Faculty has been informed of our policy/procedure regarding sponsorship and agrees to not promote the products or entity providing the financial or in-kind services.
In conjunction with the options listed above, the session will be monitored and violators of the policy will not be asked to present again.
Other. Please describe:
5. Precautions have been taken to prevent bias in the educational content as follows:
(Type an X in the white area for all that apply)
Our position on sponsorship and bias has been discussed with each presenter.
Each presenter has signed a statement that says he/she will present information fairly and without bias.
In conjunction with the options listed above, the session will be monitored and violators of the policy will not be asked to present again.
Other. Please describe:
. / 6. Nurse Planner:
Please initial or sign here to indicate that, on behalf of your agency or organization, you have reviewed
and will follow all the standards (conditions/stipulations) regarding commercial support in Appendix C of
the criteria manual.
7. Attach a signed sponsorship agreement
Note: The attached sample format for a sponsorship agreement may be used. INA, as an approver unit, may not co-sign commercial support agreements
For Approved Provider Units Only: The amount of commercial support provided by commercial companies (as defined by ANCC
COA) for educational activities must be documented
1
Revised 11/09; New # 3 2/10