1. SLIDE 1: Scientific Planning Committee(SPC) / Organizing Planning Committee (OPC) Disclosure
SPC/OPC Name
Relationships with for-profit and/or non-profit organization: (activity/presentation)
Grant/Research Support: for-profit and/or non-profit organization name
Speakers Bureau/Honoraria: for-profit and/or non-profit organization name
Other: for-profit and/or not-for-profit organization name

2. Slide 2: Faculty/Presenter Disclosure
Faculty/Presenter Name
Relationships with Commercial Interests: (activity/presentation)
Grant/Research Support: commercial entity name
Speakers Bureau/Honoraria: commercial entity name
Other: for-profit and/or not-for-profit organization name
Disclosure statements must be displayed in writing on slides and verbalized to audience at the beginning of an activity

3. Slide 3: Disclosure of Commercial Support
Specific details of relationship: (activity/presentation)
This activity/presentation has received financial support from: commercial entity name in the form of … (educational grant, etc.…)
This activity/presentation has received in-kind support from: commercial entity name in the form of… (logistical support, etc.…)
Potential for conflict(s) of interest:
Receipt of payment/honoraria/funding received from: commercial entity name
Disclosure statements must be displayed in writing on slides and verbalized to audience at the beginning of an activity

4. Slide 4: Mitigation of Potential Bias
Description of measures taken to deal with and mitigate potential sources of bias in the activity/ presentation
Disclosure statements must be displayed in writing on slides and verbalized to audience at the beginning of an activity

5. LEARNING OBJECTIVES
Clear learning objectives state what the learner will be able to do upon completion of a continuing professional development activity, in terms of behavioral change. These behaviors and/or outcomes have been identified through the needs assessment process.
Step 1
Learning objectives begin with the phrase, “At the conclusion of this activity, participants will be able to …”
Step 2
Describe the information, skills, behaviors, or perspectives participants in the session will acquire through attendance and participation. Use verbs that describe an action that can be observed and that is measurable within the time frame of the activity.
Step 3
Conclude with the specifics of what the learner will be doing when demonstrating achievement or mastery of the objectives. Emphasize what the learner will be able to do as a result of participation in the activity.

6. LEARNING OBJECTIVES SAMPLE
At the conclusion of this activity, participants will be able to list three of the currently approved statin drugs.
At the conclusion of this activity, participants will be able to describe the physical attributes of a school-age child with undiagnosed diabetes.
At the conclusion of this activity, participants will be able to provide chronic disease management in a planned, proactive manner.