You may download the application for Trainings by clicking
here.
View approved trainings as of October 12, 2011 by clicking on the links below:
2010-2011 Approved Trainings Updated 10/11
2008-2009 Approved Trainings Updated 7/11
2006-2007 Approved Trainings Updated 10/10
2004-2005 Approved Trainings
College
Courses
Updated
4/11
Online / Home Study / Other Courses Updated 10/11
APPLICATION TO REQUEST PREVENTION CERTIFICATION HOURS
Instructions: Type or print legibly in ink. Complete all parts of this form and submit with the attachments described in Part III. See guidelines for additional information.
PART I: APPLICANT INFORMATION
Name of person sending this application: __________________________________________________
Mailing Address: ___________________________________________________________________
City:
Phone: _____________________________(day) FAX: ___________________________________
E-mail: ___________________________________________________________________________
PART II: PROGRAM INFORMATION
Title of Course/Training Event: _________________________________________________________
Sponsoring Organization/Institution: _____________________________________________________
Presenter(s)/Trainer(s): ______________________________________________________________
Date of Event: ______________________________________________________________________
Total Number of Certification Hours Requested: ______________________________
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Application
PART III: ATTACHMENTS
A copy of the event announcement/brochure (in which all required information is provided) is preferred. However, the required information can be provided in another format.
The following must be attached to this application form:
- Hour-by-hour schedule showing relevant activity or content and presenter(s).
(See definitions.)
- Brief description of the professional credentials/qualifications of the presenter(s) if not shown on program announcement. (Include, at minimum, the presenter’s degree(s), licenses/certifications, and current organizational/work affiliation.)
- List of Goal(s) and Objective(s) of the course/training event. (These will be considered for their relevance to the core areas of prevention.)
I hereby certify the information I have provided is accurate.
___________________________________________ ______________________
Signature Date
Mail completed application form with attachments to:
SCAPPA Certification Training Review
Committee
Post Office Box 1763
Fax: 803-252-0589
Email: lstuckey@capconsc.com
Revised 4/06
Vision | Mission | Benefits of Membership | Benefits of Prevention Specialist Certification | SCAPPA Membership Application | FAQ's Regarding Certification | Certification Standards and Procedures | Certification Application | Important Dates for Certification | Certification Commission members |