Application for ATF accreditation of a non-presence event
Applicant
(Please fill in completely)
Company / Department

Name (title, first name, and surname)

Address (street, zip code, city, country)

Phone / e-mail (contact details)

Alternative invoice recipient
(billing address; only if necessary):

E-mail for invoice dispatch 
(electronic invoice; please only fill in if the invoice must be sent to an e-mail address other than the applicant's)

Your order number, cost center, etc. 
(Please enter here all information that must be included on the invoice; only if necessary)

Your VAT number
(only for invoice recipients outside Germany, e.g. ATU number for Austria)

Information about the course 
The following information is mandatory for checking whether the criteria according to § 10 of the ATF statutes and the executive information for ATF accreditation are met. 
Please fill in the marked fields and add attachments (contents of the course, MC questions, references / bibliography). 
Only complete applications will be processed.
Type of accreditation (please tick): 

approved continuing education
non-veterinary professional skills
(formerly generic term "commercial-economic practice management")

Updating of the continuing education obligation 
in accordance with § 7 (2) SchHaltHygV 
(legal requirements for German veterinarians) 
Type of accreditation (please tick): 

New application
(first-time application for the following training course)

Repeat application / extension application for max. 12 months 
(new application for the following training course)
Number of accreditation
(only for repeat applications, information required)

Course title
(Please state the title used for publication and application)

Organizer
(Please indicate name and address, if not simultaneously applicant)

Speakers
(Please provide the following information about the speakers: Title, first and last name, veterinarian status. For non-veterinary speakers in particular, the following information is also required: information on profession, state-recognized professional qualification and any other information).

Participants
(Please indicate the professional qualifications of the participants. Especially for non-veterinary participants, the following additional information is required: information about a completed, state-approved education, profession, further information, if applicable)

Participation options
(Please indicate whether participation is possible only in the entire event or also in individual parts. This information is mandatory for the appropriate calculation of the ATF hours.)

Public accessibility

Yes																							No

(What are the accessibility restrictions? Participation for members of an organization/association? Participation for people with previous knowledge? Participation for members of a practice/clinic/veterinary practice operator [e.g. AniCura, SmartVet, Evidensia etc.]? etc.)

Public announcement

Yes																							No

(Where is the event announced in media freely accessible to veterinarians [mandatory for ATF accreditation]? Please name the website [specify link] or magazine [specify title and issue]).

Learning success control (number of MC questions, at least 5 questions per ATF hour)

Type of course (please tick):
journal				online seminar			e-learning 			book chapter			DVD / video

other				   (please explain type of event)

Start of the course** (date, time if applicable)

End of the course** (date, time if applicable)

Dead line of the learning success control** (date, if different from the end of the course) 

** ATF accreditation is limited to a maximum of 1 year.
Duration of the course:
(hours, i.e. amount of ATF hours; estimate of the organizer)

DETAILED INFOMATION ABOUT THE COURSE 
(please fill in completely for A or B and add attachements)
A: E-Learning / online seminar / other
URL / Web address (Where will the course be held?)

Extent of the course (Number of slides / Duration of films and / or audio files [minutes] 

Access data (for ATF – username, password)

B: Veterinary journal / book chapter / DVD / video / other
Name

Issue / Year / page number

ISSN / ISBN / ISAN

Entry in Master Journal List (for articles in veterinary journals https://mjl.clarivate.com/home )
Yes 		No		     
Extent of the course 
(veterinary journal/textbook: number of words of the article (incl. figures and tables) and MC questions without bibliography - DVD / video / other: duration in minutes) 

URL / web-address (with possibility to answer MC questions online)

Completeness checklist

The following documents are attached:
		application form	

	course contents (please choose)
	journal / book chapter / other: article incl. tabels/figures in one file 
[docx, rtf; pdf]
online seminar / e-learning / other: article / presentation / film incl. sound setting (if applicable) as file 
[pptx, pdf; avi, mpeg, wav]

		literature (bibliography / references), if not already included in the content

		MC questions with marking of solutions

		access data for ATF (e-Learning / online seminar / other)

	I agree to the processing of my personal data for this application for ATF accreditation (please mark with a cross; see Data protection information)	

Place, date		Signature	

Please send your application via e-mail to atf@btkberlin.de.