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COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

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CCDP Checklist for applicants new to PCB<br />

The following should be included in the CCDP Application:<br />

________1. Completed application<br />

________2. Experience Verification Form(s)<br />

________3. Signed Code of Ethical Conduct<br />

________4. Completed and notarized Release Form<br />

________5. 110 hours of documented education, if applicable, including<br />

______ 6 in ethics<br />

______ 6 in cultural competency<br />

______ 6 in communicable diseases<br />

________6. Supervision Form completed by supervisor<br />

________7. Copy of license and specialized credential, if applicable; you are exempt from education requirements<br />

________8. Documentation of college internship/practicum, if applicable (letter from agency); you are exempt from education<br />

requirements<br />

________9. $200.00 non-refundable fee payable to PCB<br />

To be sent separately:<br />

________10. Official college transcript<br />

Photocopy entire application for your records. Send original application, all required documentation, and payment to:<br />

PCB<br />

298 S. Progress Avenue<br />

Harrisburg, PA 17109<br />

(717) 540-4455<br />

(717) 540-4458 – fax<br />

email: info@pacertboard.org<br />

website: pacertboard.org<br />

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