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Certification Commission Policy and Procedure Manual

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APPENDIX 3 E cont’d<br />

CANDIDATE:<br />

Page 3<br />

If Status Denied, the Subcommittee Must Choose One of the Following Actions (See<br />

Current Edition Of ACPE St<strong>and</strong>ards). Check which action is chosen:<br />

_______ Invite the Associate Supervisor to seek a return review after fulfilling the<br />

recommendations of the <strong>Certification</strong> <strong>Commission</strong>, providing the Associate<br />

Supervisor consults annually with the regional certification committee <strong>and</strong> is<br />

granted one-year extension by the Committee.<br />

________ Withdraw the certification of the Associate Supervisor <strong>and</strong> grant a reversion<br />

to the status of Supervisory C<strong>and</strong>idate.<br />

Recommendations or Reasons for this Action:<br />

SUBCOMMITTEE MEMBERS:<br />

(Please Print)<br />

_____________________________________<br />

Presenter<br />

_____________________________________<br />

Sub-committee chair<br />

_____________________________________<br />

_____________________________<br />

_____________________________<br />

_____________________________________<br />

<strong>Certification</strong> <strong>Commission</strong> Chair<br />

27

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