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

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

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09.02.2014 Views

CCDP Checklist for applicants new to PCB The following should be included in the CCDP Application: ________1. Completed application ________2. Experience Verification Form(s) ________3. Signed Code of Ethical Conduct ________4. Completed and notarized Release Form ________5. 110 hours of documented education, if applicable, including ______ 6 in ethics ______ 6 in cultural competency ______ 6 in communicable diseases ________6. Supervision Form completed by supervisor ________7. Copy of license and specialized credential, if applicable; you are exempt from education requirements ________8. Documentation of college internship/practicum, if applicable (letter from agency); you are exempt from education requirements ________9. $200.00 non-refundable fee payable to PCB To be sent separately: ________10. Official college transcript Photocopy entire application for your records. Send original application, all required documentation, and payment to: PCB 298 S. Progress Avenue Harrisburg, PA 17109 (717) 540-4455 (717) 540-4458 – fax email: info@pacertboard.org website: pacertboard.org 13

CCDP Checklist for applicants with a current PCB credential The following should be included in the CCDP Application: ________1. Completed application ________2. Integrated Services Experience Verification Form(s) only - (counseling employment verification not necessary) ________3. Signed Code of Ethical Conduct (if no other has been sent within the past year) ________4. Completed and notarized Release Form (if no other has been sent within the past year) ________5. 35 hours of documented education integrated and specifically related to clients with co-occurring disorders, including 6 in cultural competency CCSM, CCRM, CCMS only need send 35 hours of education integrated and specifically related to clients with co-occurring disorders ________6. Supervision Form completed by supervisor ________7. Copy of license and specialized credential, if applicable; (you are exempt from all education requirements) ________8. Documentation of college internship/practicum, if applicable (letter from agency); (you are exempt from all education requirements) ________9. $200.00 non-refundable fee payable to PCB Photocopy entire application for your records. Send original application, all required documentation, and payment to: PCB 298 S. Progress Avenue Harrisburg, PA 17109 (717) 540-4455 (717) 540-4458 – fax email: info@pacertboard.org website: www.pacertboard.org 14

CCDP Checklist for applicants with a current PCB credential<br />

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

________1. Completed application<br />

________2. Integrated Services Experience Verification Form(s) only - (counseling employment verification not necessary)<br />

________3. Signed Code of Ethical Conduct (if no other has been sent within the past year)<br />

________4. Completed and notarized Release Form (if no other has been sent within the past year)<br />

________5. 35 hours of documented education integrated and specifically related to clients with co-occurring disorders,<br />

including 6 in cultural competency<br />

CCSM, CCRM, CCMS only need send 35 hours of education integrated and specifically related to clients with<br />

co-occurring disorders<br />

________6. Supervision Form completed by supervisor<br />

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

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

education requirements)<br />

________9. $200.00 non-refundable fee payable to PCB<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: www.pacertboard.org<br />

14

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