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							Approval of Sponsors of Continuing Education
              for Psychologists
                Application

                January 2012
                 FEE NOTICE
    Sponsor Approval System Fees as of January 1, 2010

Application Fee (must accompany application)             $365
($220 for State/Regional Psychological Associations and APA Divisions)
If any deadline falls on a Saturday the application is due by 5pm EST
the preceding Friday. If any deadline falls on a Sunday the application
is due by 5pm EST the following Monday.
If you require an invoice in order to make payment please call 202-336-5820.

Late Application Fee                                     $175
This fee will be applied to all applications received after 5pm EST on
the due dates. Applications submitted after the deadline will only be
accepted at the discretion of the CE SAS Office.

Annual Fee                                               $485
($300 for state/regional psychological associations and APA Divisions)
Invoice will be sent upon approval. Do not send with Application.


Recognition Fee (new applicants only)                    $600
($360 for state/regional psychological associations and APA Divisions)
Invoice will be sent upon approval. Do not send with application.

 * All fees can be paid via credit card by calling 202-336-5820 *
                 NOTICE
Sponsors and applicants are advised that inherent in adhering to the prinicple of
Standard B of the Standards and Criteria, it is their responsibility to maintain a
continuing awareness of the policies and procedures of the APA Sponsor
Approval System. This includes, but is not limited to, having a copy of the
most recent submissions to the Office of CE Sponsor Approval (application,
review responses, etc.) being aware of report and fee submissions deadlines,
and keeping the Sponsor Approval aware of any changes in contact information
so that we may inform your organization of these deadlines in a timely manner.
The office will use contact information on file to notify individuals or
organizations of decisions, deadlines, and reminders.
                 AMERICAN PSYCHOLOGICAL ASSOCIATION
                   APPLICATION FORM FOR SPONSORS OF
           CONTINUING EDUCATION PROGRAMS FOR PSYCHOLOGISTS

This application is arranged in sections that correspond to the Standards and Criteria for Approval of
Sponsors of Continuing Education for Psychologists. A number of sections require you to submit
attachments. Attachments should be inserted after each relevant section, not at the end of the
application. Handwritten applications will not be accepted.

You must send FOUR COPIES (original and three copies) of the completed application,
including all supplemental materials. All four copies should be submitted unbound (i.e., not in 3-
ring binders, spiral bound, etc.). You are encouraged to use tabs to separate the sections.



THIS APPLICATION MUST BE ACCOMPANIED BY THE APPROPRIATE FEE BEFORE
IT WILL BE REVIEWED. ($365 for institution or private agency/individual; $220 for APA Division or
State/Regional Association)



Organization

CE Contact Person

Mailing Address

City                                                State                          Zip Code

Phone                         Fax                   E-mail                         Web Address
                     APPLICATION FOR APA SPONSOR APPROVAL OF
                     CONTINUING EDUCATION FOR PSYCHOLOGISTS

                                    GENERAL INFORMATION


Please indicate the following (check all that apply):

1.     TYPE OF ORGANIZATION

               Univ./College: Psychology Dept.              Professional Society/Association
               Univ./College: Other Division                Hospital/Medical School
               Private Educational Organization             Mental Health Center/Clinic
               Professional School of Psychology            Government Agency
               APA Division                                 Individual
               State or Regional Psychological              Other (Specify)
               Association

2.     MAJOR GOALS AND FUNCTIONS OF YOUR ORGANIZATION

       a.      What are the major goals and functions of your organization? (This question refers to
               the overall, or parent, organization. If your organization's only function is to offer
               continuing education, please indicate so in response to this question, and provide a
               more detailed description of your organization's purpose in response to Question
               A.1.).




3.     APPROVAL HISTORY

       Have you previously applied to APA for approval as a sponsor of continuing education for
       psychologists?

             NO
             YES     If yes, date of application            Decision
                                               (Month/Year)

4.     TARGETED AUDIENCE

       Indicate ALL groups you have targeted as potential participants in the activities you intend to
       offer for credit:

               Psychologists                  Physicians
               Psychiatrists                  Educators
               Social Workers                 Graduate Students
               Nurses                         Undergraduate Students
               Other (Specify)
Standard A: Goals

PRINCIPLE

Continuing education in psychology builds upon a completed doctoral program in psychology.

Continuing education (CE) in psychology is an ongoing process consisting of formal learning
activities that (1) are relevant to psychological practice, education and science, (2) enable
psychologists to keep pace with emerging issues and technologies, and (3) allow psychologists to
maintain, develop, and increase competencies in order to improve services to the public and
enhance contributions to the profession.

CRITERION

1. Sponsors must have a statement of goals for their CE program that reflects this Principle.

                                        ********************
                                             QUESTION
                                        ********************

1.     Please state the goals of your continuing education program as they relate to doctoral-level
       psychologists.
Standard B: Program Management

PRINCIPLE

Effective program management is essential for maintaining the highest quality in continuing
education programs for psychologists.

CRITERIA

1. Sponsors must include the direct input of psychologists in all phases of the decision-making and
   program-planning process for the activities offered to psychologists for CE credit.
2. Sponsors must have a clearly designated program administrator who is responsible for ensuring
   that the organization meets the Standards described in this document.
3. Sponsors must ensure the security of tests and proprietary information, and the confidentiality of
   individuals and organizations.
4. Sponsors must have written procedures for addressing participant complaints in a reasonable, ethical,
   and timely fashion.
5. Sponsors must select instructors and develop program materials that respect cultural, individual, and
   role differences, including those based on age, gender, gender identity, race, ethnicity, culture,
   national origin, religion, sexual orientation, disability, language, and socioeconomic status.
6. Sponsors must make all CE programs accessible to individuals with disabilities, according to the
   requirements of the Americans with Disabilities Act.
7. Sponsors must adhere to all Standards in this document in all aspects of CE programs offered under
   the auspices of their APA approval.

                                     ********************
                                         QUESTIONS
                                     ********************

1.     Provide below a list of names, highest degree earned and employment setting of
       psychologists responsible for program planning, and describe the contribution of each
       individual to the planning process. Provide only the names of doctoral-level
       psychologists. You must provide as an attachment a full CV for each individual named
       below. For larger planning committees, do not submit more than three CVs.

       Name            Degree         Employment Setting Role in Program Planning




1.a.   If the above individuals work as part of a committee or advisory group, please describe
       how the committee functions as a whole and how often it meets.
1.b.   If you are a single-person provider, please describe the mechanisms you have in place to
       obtain feedback from other psychologists regarding program planning, and areas where
       conflicts of interest might occur (e.g., resolution of participant complaints).




2.     Who is the administrator of your CE program? Describe how this individual ensures that
       the Standards and Criteria and Policies and Procedures of the Sponsor Approval System
       are upheld.




3.     Describe your method for ensuring the security of tests and proprietary information, and
       the confidentiality of individuals and organizations .




4.     Describe your procedures for dealing with participant complaints. You must attach a
       copy of the written procedures that you would provide to participants upon request.




5.     How do you a) select instructors and b) develop content that respects issues of diversity?




6.     Describe your method for ensuring that your programs are accessible to participants with
       disabilities (e.g., physical, visual, and/or hearing impairments).
7.   Do you collaborate with other organizations to provide continuing education programs for
     psychologists? ___ Yes        ___ No

     If you collaborate with other organizations, do you take responsibility for ensuring that all
     criteria are met?
      ___ Yes        ___ No

     If you collaborate with other organizations to offer CE programs for psychologists,
     provide an attachment that lists the names of the organizations with whom you
     collaborated over the past year, the program titles, and program dates. Corresponding
     promotional materials for all listed programs must be provided in Section G. Promotion
     and Advertising of Programs.
REQUIRED ATTACHMENTS FOR SECTION B:


     CVs of psychologists involved in program planning and development (as listed in
      question B 1)

     Written procedures for dealing with participant complaints

     List of collaborating organizations, program titles and dates (if applicable)
                              Sample Grievance Procedure

                                    GRIEVANCE PROCEDURE
[name of organization] is fully committed to conducting all activities in strict conformance with the
American Psychological Association's Ethical Principles of Psychologists. [name of organization] will
comply with all legal and ethical responsibilities to be non-discriminatory in promotional activities, program
content and in the treatment of program participants. The monitoring and assessment of compliance with
these standards will be the responsibility of the Education Chair in consultation with the members of the
continuing education committee, the [name of organization] Ethics Chairperson and the Convention
Chairperson.

While [name of organization] goes to great lengths to assure fair treatment for all participants and
attempts to anticipate problems, there will be occasional issues which come to the attention of the
convention staff which require intervention and/or action on the part of the convention staff or an officer of
[name of organization]. This procedural description serves as a guideline for handling such grievances.

When a participant, either orally or in written format, files a grievance and expects action on the complaint,
the following actions will be taken.

1. If the grievance concerns a speaker, the content presented by the speaker, or the style of presentation,
the individual filing the grievance will be asked to put his/her comments in written format. The CE Chair
will then pass on the comments to the speaker, assuring the confidentiality of the grieved individual.

2. If the grievance concerns a workshop offering, its content, level of presentation, or the facilities in which
the workshop was offered, the convention chair will mediate and will be the final arbitrator. If the
participant requests action, the convention chair will:

a. attempt to move the participant to another workshop or

b. provide a credit for a subsequent year's workshop or

c. provide a partial or full refund of the workshop fee.

Actions 2b and 2c will require a written note, documenting the grievance, for record keeping purposes.
The note need not be signed by the grieved individual.

3. If the grievance concerns [name of organization] CE program, in a specific regard, the CE Chair will
attempt to arbitrate.

Please contact [name, address, e-mail, phone number] to submit a complaint, or if you have
additional questions.
Standard C: Educational Planning and Instructional Methods

PRINCIPLE

Successful continuing education in psychology requires: (1) careful educational planning that
results in a clear statement of educational objectives; (2) the selection of appropriate instructional
methods to achieve those objectives; and (3) the selection of instructional personnel with
demonstrated expertise in the program content.

CRITERIA

1. Sponsors must develop educational objectives that clearly describe what participants are
   expected to learn.
2. Sponsors must select instructors with expertise in the program content and who are
   competent to teach this program content at a level that builds upon a completed doctoral
   program in psychology.

                                      ********************
                                          QUESTIONS
                                      ********************

   For your four most recent programs, complete the chart on the following page that lists the
   activity titles, number of credits awarded, instructional method, learning objectives, and
   instructor name and degree(s). A CV demonstrating expertise in the content area must be
   provided for each instructor.

   **If one or more of the activities listed is part of a multi-session program for which credit is
   earned on a session-by-session basis, you should only list four individual session names.
   Do not list the overall conference.**

   If you are a new applicant and have not yet offered any CE activities, you must provide this
   information for programs you plan to offer in the future.
                                     Summary Data for Four Most Recent CE Activities


Activity Title & Date   # of Credits Awarded     Instructional Method*     Learning Objectives     Instructor(s)




* Under the instructional method category, indicate the delivery method used for the activity (e.g., workshop, seminar, book, CD-
ROM, etc.)
FOR HOMESTUDY PROVIDERS ONLY:

2.   Do you offer homestudy/distance-learning programs? ___ Yes      ___ No

     If you answered yes, check the delivery method(s) used:

     ___    Publication (book, magazine, journal article, etc.)

     ___    Video

     ___    On-line

     ___    CD-ROM

     ___    Other (specify):




3.   List below the name and degree of the individual(s) responsible for homestudy program
     development and test preparation. A full CV must be included as an attachment for each
     individual.
REQUIRED ATTACHMENTS FOR SECTION C:

     Full CVs of instructors (if an instructor is also involved in program planning and
      development and a CV is provided in Section B, you do not need to provide another CV.
      Please reference Section B.)
     Full CV for individual(s) responsible for homestudy program and test preparation (if
      applicable)
                       Writing Behavioral Learning Objectives and Assessments


 Learning objectives, or learning outcomes, are statements that clearly describe what the learner will know or be
  able to do as a result of having attended an educational program or activity.

 Learning objectives must be observable and measurable.

 Learning objectives should (1) focus on the learner, and (2) contain action verbs that describe measurable
  behaviors

 Verbs to consider when writing learning objectives:

       list, describe, recite, write
       compute, discuss, explain, predict
       apply, demonstrate, prepare, use
       analyze, design, select, utilize
       compile, create, plan, revise
       assess, compare, rate, critique

 Verbs to avoid when writing learning objectives

       know, understand
       learn, appreciate
       become aware of, become familiar with

 Example of well-written learning objectives:

   This workshop is designed to help you:
   1. Summarize basic hypnosis theory and technique;
   2. Observe demonstrations of hypnotic technique and phenomena;
   3. Recognize differences between acute and chronic pain;
   4. Utilize hypnosis in controlling acute pain;
   5. Apply post-hypnotic suggestions to chronic pain; and
   6. Practice hypnotic technique in dyads.

 Objective learning assessments should be written in a manner that determines whether participants learned what
  you planned to teach them. The evaluation (or learning assessment) should be based on the stated learning
  objectives of the program.

 Example of well-written learning assessment:

   Based on the content of the workshop, I am able to:                 Strongly Agree Strongly Disagree

   1.   Describe at least two theoretical approaches to hypnosis;             5     4     3    2     1
   2.   Employ at least two hypnotic induction techniques;                    5     4     3    2     1
   3.   Explain how psychological approaches differ when applied
        to acute vs. chronic pain;                                            5     4     3    2     1
   4.   Demonstrate a technique for applying hypnosis to acute pain;          5     4     3    2     1
   5.   Provide a post-hypnotic suggestion for controlling
        chronic pain; and                                                     5     4     3    2     1
   6.   State that I had the opportunity to practice the technique
        during the workshop.                                                  5     4     3    2     1
Standard D: Curriculum Content

PRINCIPLE

The content of continuing education is the crucial component of programs intended to maintain,
develop, and increase conceptual and applied competencies that are relevant to psychological
practice, education, and science. CE programs may include content related to well-established
psychological principles, or may be based on content that extends current theory, method, or
practice. CE programs may provide information related to ethical, legal, statutory or regulatory
policies, guidelines, and standards that impact psychology.

CRITERIA

1. Sponsors must be prepared to demonstrate that information and programs presented are based
   on a methodological, theoretical, research, or practice knowledge base. This requirement
   must be met by at least one of the following:

   1.1. Program content has obtained credibility, as demonstrated by the involvement of the
        broader psychological practice, education, and science communities in studying or
        applying the findings, procedures, practices, or theoretical concepts;
   1.2. Program content has been supported using established research procedures and scientific
        scrutiny;
   1.3. Program content has peer reviewed, published support beyond those publications and
        other types of communications devoted primarily to the promotion of the approach;
   1.4. Program content is related to ethical, legal, statutory or regulatory policies, guidelines,
        and standards that impact psychology.

2. Sponsors are required to ensure that instructors, during each CE presentation, include
   statements that describe the accuracy and utility of the materials presented, the basis of such
   statements, the limitations of the content being taught, and the severe and the most common
   risks.
3. Sponsors must offer program content that builds upon the foundation of a completed doctoral
   program in psychology.
4. Sponsors must be prepared to demonstrate that content is relevant to psychological practice,
   education, or science.
5. Sponsors must clearly describe any commercial support for the CE program, presentation, or
   instructor to program participants at the time the CE program begins. Any other relationship
   that could be reasonably construed as a conflict of interest also must be disclosed.
                                       ********************
                                           QUESTIONS
                                       ********************

1.       For each of the activities listed in response to Question C.1 of this application, indicate
         which aspects of Criterion 1 your programs meet. Briefly describe how the program
         content meets the specified criterion, providing relevant references or up to 5
         representative citations. You must check the applicable box(es) and provide a
         narrative.

        Program content has obtained credibility, as demonstrated by the involvement of the
         broader psychological practice, education, and science communities in studying or
         applying the findings, procedures, practices, or theoretical concepts.

        Program content has been studied according to established procedures of scientific
         scrutiny that can be reasonably relied upon.

        Program content has peer reviewed, published support beyond those publications and
         other types of communications devoted primarily to the promotion of the approach.

        Program content is related to ethical, legal, statutory or regulatory policies, guidelines,
         and standards that impact psychology.




2.       Describe how you will request that instructors include statements that describe the
         accuracy and utility of the materials presented, the basis of such statements, the
         limitations of the content being taught, and the severe and the most common risks.




3.       Describe how you will inform participants of potential conflict of interest (e.g., commercial
         support interest for sponsors, instructors, content of instruction, or any other relationship
         that could reasonably be construed as a conflict of interest).
               Criteria and Processes for Determining Proposed Programs’ CE-Eligibility

Acceptable programs must adhere to the definition of continuing education in that they improve service to the public
and enhance contributions to the profession. Programs that address the personal or professional well-being of the
psychologist must also demonstrate how they meet the above definition.

Determination of eligibility is not made on the basis of topic alone. The responsibility is on the applicant to
adequately establish the bridge between program content and the elements of the criteria. The more distant a topic
appears from core disciplinary knowledge, the greater the responsibility of the sponsor to demonstrate the connection
to improvement of services to the public and contributions to the profession.

The CE Committee will use the Standards and Criteria for Approval of Sponsors of Continuing Education to
evaluate proposals. In so doing, they will employ the following evaluative steps:

                                                  Intent
                           Will it help psychologists better serve the public
                                      and enhance the profession?
                           public
                                                       yes                    no


                                        Can it be understood
                                        as building on a doctoral                       Reject
                                                                           no
                                        degree in psychology?

                                                        yes                      no


                                                              ;
                            Is it credible (e.g., theoretically empirically; accepted
                            conventional practice) or does it address legal, ethical, or
                            regulatory professional standards?

                                                        yes

                                     Proceed to Evaluation Using
                                           Additional Criteria

                                             Criteria

                       ILLUSTRATIVE EXAMPLE: BUILDING YOUR PRACTICE
        Insufficient learning objectives                             Acceptable learning objectives
         Compare advantages and                                 Identify the professional, legal and ethical
          disadvantages of buying versus                          issues related to buying versus renting office
          renting office space                                    space
         Learn to read a financial report                       List three regulatory issues concerning
                                                                  electronic medical records and billing systems
         Maximize income from managed                           Negotiate contracts for managed care services
          care                                                    which maximize patient care
         Develop successful strategies for                      Analyze and minimize confidentiality concerns
          locating sublettors for office space                    involving shared office space
         Maximize case load through                             Create ethically sound marketing tools and
          successful marketing                                    techniques
         Design promotions to attract the                       Provide effective client advocacy to third party
          self-pay clientele                                      payors

Note: Insufficient learning objectives successfully articulate the advantages that might accrue to the practitioner,
but do not extend these to underscore their value to the clients or the broader society that may follow from the
knowledge gains associated with this program. Acceptable learning objectives, by comparison, clearly identify the
broader contributions that might support the welfare of the consumer and the society by addressing ethical and
regulatory implications associated with successful business practice.
Criterion D 1 needs to be satisfied in one or more of the following four ways. Although any
given program may utilize two or more of these criteria, only one is required. Programs are not
advantaged by selecting more than one of the four criteria to satisfy Criterion D1. Each of the
four criteria (1.1, 1.2, 1.3, and 1.4) are designed to satisfy Criterion D 1 in qualitatively different
ways.

Criterion 1.1 reflects the broad consensus of the discipline of psychology in relation to content
that is generally accepted as building upon doctoral level training within core areas of
psychology. As an example, a program focused on the dialectic conceptualization of borderline
personality disorder might use Criterion 1.1 to satisfy Criteria D1 because dialectic theory is a
commonly accepted theory. A discussion of theoretical developments concerning borderline
personality disorder might build upon the foundational knowledge of the disorder.

Criterion 1.2 reflects program content that has been subjected to accepted research practices
within psychology and has satisfied broader scientific scrutiny within the field. The emphasis of
Criterion 1.2 is placed on the application of sound methodological practices and the availability
of scientific support for the program content. As an example, a program focused on a new
instrument for assessing, or a new intervention for treating, borderline personality disorder might
use Criterion 1.2 to satisfy Criterion D1 by clearly describing empirical work or citing published
research that supports the validity of the program content.

Criterion 1.3 reflects program content that has been subjected to mechanisms of external
professional peer review. This content can extend beyond empirical research (cf. Criterion 1.2)
and may include theoretical, conceptual, case studies or secondary research reviews. Criterion 1.3
emphasizes the acceptability of program content based on peer review in journals, professional
conferences, or venues of independent review that support the relevance and acceptability of
program content for the discipline of psychology. As an example, a program focused on a new
theoretical development concerning borderline personality disorder might use Criterion 1.3 to
satisfy Criteria D 1 by citing peer reviewed publications (not necessarily empirical) or
presentations that support this program content.

Criterion 1.4 reflects program content that pertains to ethical, professional or regulatory
developments relevant to the discipline of psychology. As an example, Criterion 1.4 might be
used to satisfy Criterion D 1 in relation to a program that emphasizes the personal or legal risks
and risk management associated with working with individuals with borderline personality
disorders.
Sample Response to D.1. – Course Content Requiring Citations


The demonstration of program credibility can include citations to relevant peer-reviewed research, and
reference to broader, recognized traditions of research and theory, among others:

Example D.1. “The Use of Expressive Arts in Psychotherapy”

Insufficient Response

The use of expressive arts in psychotherapy has a longstanding tradition. Music, dance and other creative
arts are valuable additions to successful psychotherapeutic practice. This program illustrates a range of
expressive arts and their potential applications in the treatment of emotional distress.

Drawing from their extensive clinical experience, the presenters demonstrate a variety of expressive
techniques that help open clients to new forms of mental health, adjustment, and optional functioning by
helping them to recognize and experience their internal response.

This program is derived from the work of S. Smith, Clinical Applications of the Expressive Arts (New
York: Stonewall Publications, 2000).


Acceptable Response

The use of expressive arts in psychotherapy has a longstanding tradition. Music, dance and other creative
arts are valuable additions to successful psychotherapeutic practice. This program illustrates a range of
expressive arts and their potential applications in the treatment of emotional distress.

Drawing from the fields of art therapy, dance therapy, and other allied fields of recreational and
occupational therapy, this program overviews the historical traditions, current research findings, and
practice knowledge that inform the application of arts in psychotherapeutic practice.

This program is derived from the following works:

McNamara and Scott (2000), Historical Research in Music Therapy, 3rd Edition.

Douglas, D.B., (2001). Effectiveness of the Expressive Arts in Psychotherapeutic Practice: Documentation
of Research in Clinical Practice. Journal of Arts in Medicine, 3, 121-134.

Stanford, L.M. and Dickson, E.E. (2001). A controlled study of the effects of expressive arts as adjunctive
techniques in psychotherapy. Journal of Psychotherapy Research, 33, 211-228.


Note: The insufficient program description draws primarily from presenter experience and only minimal,
non peer-reviewed publications. The acceptable response clearly identifies relevant research literature
that supports both the application of the expressive arts and their associated outcomes within relevant
clinical contexts.
Illustrative Learning Objectives
Title: Succeeding in an Academic Career

At the conclusion of this program, participants will be able to:

Insufficient Learning Objectives

    1.   identify the advantages in advancing one’s career of having a systematic research program
    2.   manage the complexities of scheduling research assistants, supervisees and other helpers
    3.   negotiate the ins and outs of getting publications and grants
    4.   discharge advising obligations while still having time to write
    5.   increase chances for retention, tenure, and promotion through understanding academic policies and
         the administrative structure

Acceptable learning objectives
   1. identify the practical applications for teaching effectiveness of building a systematic research
       program
   2. identify relevant ethical codes associated with research, clinical, or academic supervision with
       students
   3. negotiate the regulatory and ethical information regarding publication and grant writing with
       colleagues or students
   4. apply appropriate mentoring skills for maximal student growth
   5. use an understanding of academic policies and the administrative structure to create more efficient
       classrooms and labs

Note: Insufficient learning objectives identify the advantages that might accrue to the individual faculty
member, but fail to link these to improved services and the broader regulatory, ethical or professional
issues that might also serve broader constituents within this context. By contrast, the acceptable learning
objectives effectively tie the knowledge gains associated with this program to the effective functioning of
the students and the administrative units associated with the faculty’s functioning, and highlight the
professional and scientific gains that would be expected to accrue as a result of the program.
Standard E: Program Evaluation

PRINCIPLE

Evaluation of CE programs is for the purpose of improving future programs.

CRITERIA

1.     Sponsors must obtain the CE participants’ evaluation as to how well each educational
       objective was achieved.
2.     Sponsors must assess the participants’ satisfaction, using a written evaluation form, with
       the overall program.
3.     Sponsors must ensure that there is a method in place to assess what the participants have
       learned from the program.
4.     Sponsors must use the results of the abovementioned evaluation processes to
       improve and plan future programs.

                                    ********************
                                        QUESTIONS
                                    ********************

1.            Describe your method for assessing participant satisfaction with the program. You
              must attach a sample of your written evaluation form. Every evaluation form must
              include the following question: How much did you learn as a result of this CE
              program?       1       2     3       4      5
                             Very little           Great Deal




2.     Describe your method for assessing the level of learning achieved by all participants.




3.     Describe how evaluation feedback is used to improve and plan future programs.
3.a.   For the four programs listed in Standard C, you must provide a quantitative
       summary of the evaluations.
REQUIRED ATTACHMENTS FOR SECTION E:

     Evaluation form including required overall assessment of learning.

     Measure of achieved learning (e.g., post-test) – required for homestudy providers. Must
      indicate activity title and number of credits awarded (2b).

     Evaluation summaries for the four programs listed in Standard C.
        CE Program Title
        Sponsoring organization
        Date
                                                                                               Neither
                                                                        Strongly                Agree              Strongly
                                                                        Disagree    Disagree     nor       Agree    Agree

             Instruction
1. The program objectives were met.
                                                                                               Disagree



          A. Objective #1 (Write out specific objective)                    1          2           3        4         5
          B. Objective #2 (Write out specific objective)                    1          2           3        4         5
          C. Objective #3 etc. (Write out specific objective)               1          2           3        4         5
2. Accuracy and utility of content were discussed.                          1          2           3        4         5
4. Content was appropriate for postdoctoral level training                  1          2           3        4         5
5. Instruction at a level appropriate to postdoctoral level training.       1          2           3        4         5
6. Teaching methods were effective.                                         1          2           3        4         5
7. Visual aids, handouts, and oral presentations clarified content          1          2           3        4         5


Instructor 1:                                                                                  Neither
                                                                        Strongly                Agree              Strongly
Name:                                                                   Disagree    Disagree     nor       Agree    Agree
                                                                                               Disagree
8. Knew the subject matter                                                  1          2           3        4         5
9. Taught the subject competently                                           1          2           3        4         5
10. Elaborated upon the stated objectives                                   1          2           3        4         5
11. Presented content in an organized manner                                1          2           3        4         5
12. Maintained my interest                                                  1          2           3        4         5
13. Answered questions effectively                                          1          2           3        4         5
14. Was responsive to questions, comments, and opinions                     1          2           3        4         5


Instructor 2:                                                                                  Neither
                                                                        Strongly                Agree              Strongly
Name:                                                                   Disagree    Disagree     nor       Agree    Agree
                                                                                               Disagree
8. Knew the subject matter                                                  1          2           3        4         5
9. Taught the subject competently                                           1          2           3        4         5
10. Elaborated upon the stated objectives                                   1          2           3        4         5
11. Presented content in an organized manner                                1          2           3        4         5
12. Maintained my interest                                                  1          2           3        4         5
13. Answered questions effectively                                          1          2           3        4         5
14. Was responsive to questions, comments, and opinions                     1          2           3        4         5


Professional & Ethical Issues
15. Presenter (or program chair, etc.) made clearly evident, prior to registration, the following:
a. Requirements for successful completion of activity                                                      Yes       No
b. Commercial support for CE program, sponsor, or instructor (or any other relationship that could
reasonably be construed as a conflict of interest)                                                         Yes       No
c. Commercial support for content of instruction (e.g., research grants funding research findings etc.)    Yes       No
that could be construed as a conflict of interest
d. Commercial support or benefit for endorsement of products (e.g., books, training, drugs, etc.)          Yes       No
e. Accuracy and utility of the materials presented, the basis of such statements, the limitations of the
content being taught and the severe and most common risks?                                                          Yes           No

                                                                                                      Does
                                                                         Strongly                     Not                       Strongly
Venue, Setting, etc.                                                     Disagree       Disagree      Apply         Agree        Agree

16. Facility was adequate for my needs                                       1              2            3            4            5
17. Special needs were met                                                   1              2            3            4            5
18. Facility was comfortable and accessible                                  1              2            3            4            5
19. Food and beverage were adequate (if applicable)                          1              2            3            4            5
20. Program brochure was informative and accurate                            1              2            3            4            5

                                                                                                        Does
                                                                         Strongly          Disagree     Not           Agree       Strongly
Learning                                                                 Disagree                       Apply                     Agree
21. Information could be applied to my practice (if applicable)                  1              2             3           4            5
22. Information could contribute to achieving personal or
professional goals.                                                              1              2             3           4            5
23. Cultural, racial, ethnic, socioeconomic, and gender differences
were considered.                                                                 1              2             3           4            5
24. How much did you learn in this course?                                                                              A
                                                                          Very Little        Little          Some      Good        A Great
                                                                                                                        Bit         Deal
25. Did this program enhance your professional expertise?                    Yes                No
26. Would you recommend this program to others?                              Yes                No




Participant Information
27. Please note your profession and status            □ Psychologist    □ Medical        □ Masters Level      □ Social Worker     □ Student
                                                                       Professional     Licensed Therapist
(Check all that apply)                              □ Administrator    □ University          □ Other:         _____________
                                                                         Faculty                              list profession
28. Please note years in your profession              □ Student          □ 1-5              □ 6-10                □ 11-20          □ 20+


Narrative
29. What was your overall impression of the activity? What went well? What could have been improved?



30. What did you learn that was new or different? How and/or will this information change how you practice?



31. What topics or presenters would you like to see at future CE presentations?



32. Other comments




Please use another sheet of paper if you wish to expand on your observations
Standard F: Standards for Awarding Credit

PRINCIPLE

The awarding of CE credit is based on participation in learning activities offered in accordance with
the Standards described in this document.

CRITERIA

1. Sponsors must award CE credit for psychologists on the basis of one credit per one hour of
   instructional time.
2. Sponsors must provide documentation to each participant that includes the APA approval
   statement, the name and date of the activity, the number of CE credits earned, and a signature or
   other verification from the sponsoring organization.
3. Sponsors must be able to verify the awarding of CE credit to participants and provide this
   verification to individuals who request it for at least three years after completion of the activity.

                                      ********************
                                          QUESTIONS
                                      ********************

    1. For all activities offered in the past year, complete the following chart that lists the activity
       title, program length (in hours), the number of credits awarded, and the number of
       psychologist and non-psychologist attendees. If you have not offered any programs in the
       past year, provide this information for your most recent activities. If you are a new applicant
       and have not yet offered any programs, provide this information for programs you plan to
       offer in the future. List only those programs that were offered to psychologists for
       credit.

       If you offer any multi-session programs (e.g., conventions, conferences) for which credit
       is earned on a session-by-session basis, you must list all the individual sessions that
       were available for credit. Do not list the overall conference.
                      Summary Data for Activities Offered in Past Year


                             Program       # of CE     NUMBER OF PARTICIPANTS
Title of Activity   Date     Length        Credits     Psychologists Non-Psychologists




Total Activities:            Total Psychologists:      Non-psychologists:___
2.   Attach a copy of your documentation of attendance.




3.   Describe your attendance policy and your method for monitoring attendance.




4.   Affirm that you agree to keep records of credit awarded to participants for a three-year
     period by check below:

     ____ Yes, I agree to keep records of credit awarded to participants for a three-year
     period.

FOR HOMESTUDY PROVIDERS ONLY:

5.   Describe in detail the process used to determine the number of credits awarded. If you have
     various program delivery methods (e.g., publication and on-line), you must describe the
     process used for each delivery method.




6.   What are the criteria that participants must meet in order to receive credit.




     6.a    For programs that use more subjective assessment measures to determine passing
            (e.g., essays, posts to an electronic bulletin board, journaling), describe your
            procedures for grading this type of material.




7.   Describe your method for verifying that the person being awarded the credit is the
     individual who completed the program.
REQUIRED ATTACHMENTS FOR SECTION F:

     List of activities offered in past year, program length, and credits

     Documentation of attendance (certificate)
                             SAMPLE
                  DOCUMENTATION OF ATTENDANCE
                             Address
                       City, State Zip Code
                          Phone Number

____________________
Date

To whom it may concern:

This is to certify that (participant's name} has attended, in its entirety, the following continuing education
activity I sponsored by (the APA-approved provider's name):
       __________________________________________________________________________
                                    Title/Date of Activity
_____________________
CE Hours/Credits

Sincerely,

_____________________________________________________________________________
Name of Presenter/Sponsoring Organization

(Name of organization) is approved by the American Psychological Association to sponsor continuing
education for psychologists. (Name of organization) maintains responsibility for this program and its
content.
Standard G: Promotion and Advertising of Programs

PRINCIPLE

CE promotional materials must contain accurate and complete information for potential program
participants.

CRITERIA

1. Sponsors must clearly indicate how potential participants may obtain the following information
   prior to enrolling in a CE program:
           a.    Educational objectives;
           b. A description of the target audience and the instructional level of the activity
                 (introductory, intermediate, or advanced);
           c.    Schedule;
           d. Cost, including all fees and the refund/cancellation policy;
           e.    Instructor credentials, including relevant professional degree and discipline, current
                 professional position, and expertise in program content;
           f.    The number of CE credits offered for each activity;
           g. A clear indication of any activities within a program that are not offered for CE
                 credit.
2. Sponsors must make clearly evident to all potential participants, prior to registration, any known
   commercial support for CE programs or instructors. Any other relationships that could be
   reasonably construed as a conflict of interest also must be disclosed.
3. Sponsors must assure that when referring to APA approval, the correct statement is used in all
   promotional materials such as ads, brochures, and announcements When referring to APA
   approval, the following statement must be used:

           "(Organization name) is approved by the American Psychological Association to
           sponsor continuing education for psychologists. (Organization name) maintains
           responsibility for this program and its content."

                                      ********************
                                          QUESTIONS
                                      ********************

1.     Provide the promotional material/announcement for the ten most recent programs
       (including those listed in Standard C). If you have not offered any programs in the past
       year, provide brochures from your most recent activity. If you are a new applicant and
       have not yet offered any CE programs, attach sample promotional materials for programs
       you intend to offer in the future. Please do not submit duplicate promotional material.


2.     If you receive commercial support for your programs, describe how you make this known
       to potential participants.
REQUIRED ATTACHMENTS FOR SECTION G:

     Promotional materials/announcements for your ten most recent programs. If new
      applicant, provide sample promotional materials for future programs.
                                     AGREEMENT

I understand that information in this application will be kept confidential except under the
circumstances stated on pages 2-3 of the 2005 Policies and Procedures Manual. I also certify that
the information provided herein is accurate, and if approved, agree to abide by the criteria and
procedures set forth in American Psychological Association Continuing Education Sponsor Approval
System Standards and Criteria, and Policies and Procedures Manual.




Signature________________________________                         Date_______________
             CE Program Director



Thank you for completing this application. Please send the original and three copies of the
completed application to:

                             APA Sponsor Approval System
                          American Psychological Association
                   750 First Street, NE, Washington, DC 20002-4242



THIS APPLICATION WILL NOT BE REVIEWED UNLESS ACCOMPANIED BY
APPROPRIATE FEE. APPLICATIONS RECEIVED AFTER THE FEBRUARY 1 OR AUGUST 1
DEADLINES WILL BE RETURNED TO THE APPLICANT OR CHARGED A LATE FEE.
                 SPONSOR APPROVAL SYSTEM CHECK LIST

In an effort to help sponsors and sponsor applicants achieve and maintain adherence with the
Sponsor Approval System Standards and Criteria, the following check list is being provided that
address common areas for errors.

Program Management

YES    NO
              Are doctoral-level psychologists involved in all phases of the decision-making and
              program planning process?
              In your application, did you provide a full CV for the psychologists involved in program
              planning (for large planning committees, submit no more than three CVs)?
              In your application, did you include a CV for the CE program administrator?
              In your application, did you include a copy of your written grievance procedures?

Educational Planning and Instructional Methods

YES    NO
              Does each program you offer have clearly stated learning objectives that describe what
              the participant will learn as a result of having attended the program?
              For multi-session conferences for which credit is offered on a session-by-session basis,
              does each session have its own stated learning objectives?
              In your application, did you provide a full CV for each instructor listed in Section C.1.?

Curriculum Content
YES NO
              If the programs listed in Section C.1. contain content that would be considered non-
              traditional or non-mainstream, did you provide research citations that support the content
              being presented?
              Did you demonstrate that the programs listed in Section C.1. meet one or more criteria
              under Criteria D.1.?

Program Evaluation and Assessment of Learning
YES NO
              Does your evaluation form include the following?
              a        Individual assessment of each stated learning objective;
              b.       Assessment of instructor knowledge and expertise;
              c.       Assessment of instructor teaching ability.
              For multi-session conferences, do you individually evaluate each session for which credit
              is being offered?
              For homestudy post-tests, is the test of sufficient depth to adequately determine the level
              of learning that was achieved (recommended number of questions: 6-8 per credit)?
              In your application, did you provide the following items: sample satisfaction evaluation
              form(s), summary of satisfaction evaluations for all programs offered in the past year,
              sample post-test (homestudy providers only)?
Standards for Awarding Credit
YES NO
            Do you require 100% attendance at programs in order to receive credit?
            Do you only offer full credit for full attendance? Partial credit for variable attendance is
            not permitted. (Please note: partial credit is different from offering credit on a session-by-
            session basis for multi-session programs. See below.)
            For programs where credit is awarded on a session-by-session basis, do you have a
            method for tracking and verifying full attendance at each session?
            For homestudy programs, do you have a method for determining credit hours and a
            rationale for this method?
            In your application, did you include a copy of your documentation of attendance (a
            certificate, not the sign-in sheets you might use to track attendance)?

Promotion and Advertising of Programs
YES NO
            Do you use the term “CE” or “CE credit only? Never use “CEU” or terms such as “APA
            Approved” or “APA credit”?
            Do your promotional materials contain the following information?
            a.     Educational objectives that are written in observable and measurable terms;
            b.     A description of the target audience and the instructional level (introductory,
                   intermediate, or advanced);
            c.     Activity schedule;
            d.     Cost of the activity, the refund/cancellation policy, and any additional fees;
            e.     Faculty credentials (i.e., relevant professional degree, current professional
                   position, areas of expertise);
            f.     The number of CE credits offered for each activity.
            g.     For multi-session conferences, does promotional material identify which sessions
                   are being offered to psychologists for credit?

            If your promotional material does not provide one or more of the above information
            items, do you provide a method for obtaining this information (e.g., web address, phone
            number)?
            Do you use only the following statement to refer to your approval? (Your organization)
            is approved by the American Psychological Association to sponsor continuing education
            for psychologists. (Your organization) maintains responsibility for this program and its
            content.
            When referring to programs you offer to psychologists for credit, do not use the term
            “accredited” or “APA approved” or any other variation therein.
            In your application, did you provide a promotional piece for each program offered in the
            past year?

						
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