CERTIFIED MEMBERS' SCORE SHEET FOR RECERTIFICATION PROGRAM

Member's name (Please print) ________________________________

Address: __________________________________________________

Date of Initial Certification: ________________

CINA (C)Number __________________ Date ____________________

CATEGORIES	POSSIBLE POINTS	YOUR POINTS
1. Conferences •Attendance at CINA convention •Attendance at other IV Conferences (documentation required) •IV related seminars/workshops (documentation required)	10 points/day (max. 30 points) 10 points/day (max. 30 points) 5 points each
2. Article Submissions •Submissions published in CINA Annual Journal •Submissions published in other journals (Date and Name of Journal) •Educational pamphlet (place of employment) •Submissions published in a Newsletter (Date and name of publication)	10 points 10 points 5 points 2 points
3. Participation in CINA Newsletter (Mainliner) •Submission of Rounds and/or IV Line quiz questions •Answers to Rounds/ IV Line questions	2 points/quiz 2 points/submission
4. Presenter/Lecturer •Lecturer at CINA Convention •Lecturer at other conference(documentation required) •Place of employment presentation (documentation required) •Poster presentation •Preparation time - 1 hr = 2 points (documentation required)	10 points 10 points 2 points per presentation 10 points per presentation 2 points per hour of preparation
5. Membership in Other Professional Organizations relating to IV Therapy •INS/NAVAN/LITE/ONS/Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •Member of National/International board or committee	5 points per year 10 points per year
6. CINA Chapter •Member of Chapter Executive •Attend Chapter Meetings •Organize New Chapter •Coordinating Chapter meeting/seminars	5 points/year 2 points per meeting 10 points 5 points per meeting/seminar
7. CINA Membership •CINA membership renewal before January31st •Recruitment of new members* (*new member is defined as someone who has not been a previous member of CINA or not been a member for at least two years) •Member in good standing - 3 - 5 years •6 - 10 years / Over 10 years	3 points/year 3 points per member 1 point additional point/additional point
8. CINA Certification Exam •Invigilate exam •Successful completion of CINA Certification Exam	5 points per examination 5 points
9. CINA Board •CINA Board member •Stand for election	10 points per year 5 points
10. Special projects (these will be considered individually. Please submit verification of project or assignment) •CINA projects •Preceptorship program, ie. Teaching resident/staff/students •Editorial Review of CINA Journal/Projects •Judging of Poster Presentations	10 points 5 points/year 5 points 3 points
11. Published Research Article (documentation required)	20 points
12. Independent Study •Reading articles and answering test questions in other professional nursing journals (documentation required)	5 points per submission
13. CINA Awards •Barbara Hill Award •Johnson & Johnson Medical Products Editorial Award •Maisie Townend Award •Winner of Poster Presentation •Winner of Certification Award	5 points 10 points 5 points 5 points 10 points
14. Formal Education •College or University course (30 hours and over - documentation required)	5 points per year

Your Total ______________

This form describes the necessary steps and lists the type of continuing education activities you can consider in order to submit recertification information to the CINA certification program. If you choose not to recertify in this manner, you will be expected to rewrite the exam to maintain certification after five years. A recertification certificate will be issued upon completion of your five year period.

Steps Necessary to Prepare recertification information for CINA Certification program

•Read the information carefully

•Use the CINA scoresheet to list your recertification activities

•Recertification information will be sent upon successful completion of certification exam. For those currently certified a form will be sent annually. It is the responsibility of each member to monitor their own recertification points

•Please submit your scoresheet yearly with your application to: CINA, 18 Wynford Drive, Suite 516, North York ON M3C 3S2.Members must have a minimum of 100 points in a five year period to obtain the recertification certificate. Effective January 2000 - You must accumulate a minimum of 100 points in a five year period from the date of initial certification to maintain your certified status. If you choose not to participate, you will be required to write a recertification examination

Point Accumulation

•A total of 100 recertification points over a five year period from the date of initial certification

•Each recertification activity must relate to IV Therapy(only exception being formal education), be a minimum of 30 minutes and earned during your five year certification term

•Preauthorization from CINA is not required in order for your activities to be eligible

•The activity can be undertaken outside of Canada. International opportunities are encouraged

Keeping Track of your Recertification Points

•Keep all documents that confirm your attendance at recertification activities. It is not necessary that these documents accompany application for recertification. We suggest that you keep them on hand. Random audits may occur

•Professionally and ethically you are the best person to make a decision about which continuing education activities you can apply towards your recertification

•It is recommended you keep a photocopy of your scoresheet to monitor your yearly progress. This will make the application easier and less time consuming

•Any member who was certified in 1996 or later may submit retroactive points. Documentation may be required

Submit completed accrual form by December 31^st of each year