Sleep - American Association of Sleep Technologists
Sleep - American Association of Sleep Technologists
Sleep - American Association of Sleep Technologists
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Publication <strong>of</strong> the <strong>Association</strong> <strong>of</strong> Polysomnographic <strong>Technologists</strong> • Summer 2006 • www.aptweb.org<br />
APT CEC Evaluation Form<br />
To earn APT CECs, carefully read four <strong>of</strong> the articles (see previous page for list) designated for APT CECs and mark your responses for each article<br />
and its page number on this form. Completely answer all questions and fax or mail this form to the APT national <strong>of</strong>fice (fax number/address indicated<br />
at the bottom <strong>of</strong> this page). In order to receive credit, this evaluation form must be answered completely and postmarked by December 1,<br />
2006. A certificate awarding 1.5 APT CECs will be mailed to you four to six weeks following this date. There is no charge to members <strong>of</strong> the APT<br />
for this service. Non-members must include payment <strong>of</strong> a $20.00 administrative fee with this form.<br />
For items 1-2, please use the following scale:<br />
5=Strongly Agree, 4=Agree, 3=Unsure, 2=Disagree, 1=Strongly Disagree<br />
Article 1 Article 2 Article 3 Article 4<br />
Page #_____ Page #_____ Page #_____ Page #_____<br />
1. Educational value:<br />
I learned something new that was important. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1<br />
I verified some important information. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1<br />
I plan to discuss this information with colleagues. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1<br />
I plan to seek more information on this topic. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1<br />
My attitude about this topic changed in some way. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1<br />
This information is likely to impact my practice. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1<br />
2. Readability feedback:<br />
I understood what the authors were trying to say. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1<br />
I was able to interpret the tables/figures (if applicable). 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1<br />
Overall, the presentation <strong>of</strong> the article enhanced my<br />
ability to read and understand it. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1<br />
Please print legibly or type:<br />
3. Additional comments/feedback to be used by the APT CEC Committee: ____________________________________________________________________________________<br />
__________________________________________________________________________________________________________________________________________________________________________________<br />
4. Commitment to change:<br />
What change(s), if any, do you plan to make in your practice as a result <strong>of</strong> reading any <strong>of</strong> these four articles? ____________________________________________<br />
__________________________________________________________________________________________________________________________________________________________________________________<br />
5. Statement <strong>of</strong> completion:<br />
I attest to having completed the APT CEC activity (sign below).<br />
Signature________________________________________________________________________ Date ______________________________________________________<br />
Phone: ______/______/__________ Fax: ______/______/__________ E-mail: __________________________________________________________________________________<br />
Name (please print legibly) __________________________________________________ RPSGT ❑<br />
Address __________________________________________________________________________________________________________________________________________________________________________________________________________________________________<br />
City_______________________________________________________________________ State_______________ Zip ______________________________________________________________________<br />
Are you a member <strong>of</strong> the APT? (circle one): Yes / No APT Membership No:_____________ (If no, complete the following payment information)<br />
❑ Check made payable to the APT for $20 is enclosed or ❑ Charge $20 to (circle one): Visa / MasterCard / <strong>American</strong> Express<br />
Card Number__________________________________________________________ Expiration Date ______/______<br />
Cardholder name (please print)_____________________________________________ Signature________________________________________________________<br />
Cardholder Address ______________________________________________________________________________________________________________________________________________________________________________________________________________<br />
Please return this completed form, postmarked no later than September 22, 2006, to the APT National Office:<br />
One Westbrook Corporate Center, Suite 920, Westchester, IL 60154, or fax to (708) 273-9344<br />
9