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Informatics Education Toolkit
Learning Activity Submission Form

CONTACT INFORMATION
*Required Fields
  
*Last Name:
*First Name:
 Middle Initial:
*Credentials: (see format below)
*Phone Number:
Alternate Number:
*Email Address:
 Affiliating Agency:
*Business Address:
Business Address 2:
*City:
*State:
*Zip:

Credentials format: Earned Degrees Only. Please list your highest earned credential first, then your license, then certification(s) and honor(s). EXAMPLE: MSN, RN, CNAA-A


*In one sentence, please describe the learning activity

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*Please describe the outcomes, objectives, or competencies related to the learning activity.

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*Please select where can this activity be used.

 
Education Level
 
*Category:
Computer Literacy
Information Literacy
Informatics*
*If Informatics: which curricular thread(s) is associated with the learning activity?
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