SCAPPA Certification Training Review Committee

You may download the application for Trainings by clicking here.

View approved trainings as of July 14, 2010 by clicking on the links below:

2010 Approved Trainings Updated 7/10

2008-2009 Approved Trainings Updated 7/10

2006-2007 Approved Trainings Updated 7/10

2004-2005 Approved Trainings
College Courses Updated 7/10

Online / Home Study / Other Courses Updated 7/10

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: ______________________________ State: ____________________ Zip Code: _____________

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: ______________________________

Core Areas	Number of Hours
I. Program and Evaluation
II. Education and Skill Development
III. Community Organization
IV. Public and Organizational Policy
V. Professional Growth and Responsibility

Total Hours Requested

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

Columbia, South Carolina 29202

Revised 4/06

Application to Request Certification Hours | History |