1.	The Collaborative Education Institute agrees to cosponsor continuing education programming with the following organization:*

Guidelines:
1. The above stated non-ACPE approved organization agrees to have one representative, designated as the CE Cosponsor Representative, who shall be exclusively responsible for the administration of continuing education, who will work closely with CEI's team, and who will be responsible for abiding by the ACPE Criteria for Quality.

2. The Collaborative Education Institute requires a non-refundable, administrative processing fee which is due at the time of program submission. A fee per participant receiving CE credit is due within 1 month following the program date.

* Please contact Jennifer Moulton, jmoulton@iarx.org or 515/270-0713 for fee structure.

	CEI Representative: Jennifer R. Moulton Title: Senior Vice President, Educational Affairs

2.	Cosponsor Representative's E-mail Address:*

CE Cosponsor:*

Representative:
Organization:
Date:

	(This agreement is effective for 2 years from the date submitted.)