NASW-NJ CE Approval Collaborative App Form

NEW JERSEY SOCIAL WORK CONTINUING EDUCATION APPROVAL COLLABORATIVE

Thank you for applying to the NJ Social Work Continuing Education Approval Collaborative, provided by the National Association of Social Workers - New Jersey Chapter. The CE Approval Collaborative offers individual course approvals to those who offer cutting-edge, beneficial courses to New Jersey social work professionals. The CE Approval Collaborative is committed to ensuring that members of our profession demand high quality education.
CE Approval Collaborative - Course Approval Application Form

Course approval: Each approval is valid for the biennial licensing period in which it was submitted (Currently September 1, 2018 to August 31, 2020). During this time, the approved course can be offered an unlimited number of times as long as there are no content and/or presenter changes.
UPDATE: This form can no longer be saved as a draft and returned to. If you are not ready to complete this application and pay in full, save all of your course information in a Word Document until you are ready to submit.

Application Instructions:
- Please complete the application thoroughly; complete all sections. Be sure to include all attachments.
- Applications are processed on a first come, first served basis.
- Submit application information at least ninety (90) days prior to each program. (NO EXCEPTIONS)
- Applications cannot be reviewed unless payment and all requested information are received.
- Allow 8 weeks for processing and review (after a correctly completed application and payment have been submitted) to be notified of the program status.
- Please provide the information requested in the required field. Attachments cannot be substituted for the requested information.
- All fields must be completed. Indicate n/a if the question is not pertinent to your course offerings.
- Documents placed in the appendix and/or uploaded as attachments must be clearly numbered and labeled according to the section(s) they support.
- Please be sure to attach documents required for the specific type of course you are providing.
- Questions? Please be sure to review the Application Guidelines and Explanation of Terms and Requirements which can be found at www.naswnj.org.
  
  For more information contact Annie at 732-296-8070, ext. 128
  asiegel.naswnj@socialworkers.org.
Contact Information
Applicant Name (Individual or Organization): *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Website URL:
Contact Person: *
Contact Person's Email: *
Contact Person's Phone Number *
Have you/your organization had individual course approval with OTHER approval entities for the course in which you are submitting this application? If so, please include entity name, whether course was approved or denied and, if applicable, date approved and approval number: *
If this does not apply to you, please indicate N/A.
Presenter(s)
Presenter name(s): *
Presenter address(s): *
Email(s): *
Presenter(s) Phone Number (s): *
Presenter(s) License Number: *
Presenter(s) NASW Member ID:
Describe relevant presenter qualifications as they pertain to course: *
Presenter Resume: *

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If additional resumes need to be attached, they can be uploaded in the Appendix section below. Cancel of
Course Overview
Course Title: *
Course Location: *
Course date(s): *
Course Description: *
Course Outline: *
This outline should display a course breakdown with a timed schedule of the day's event(s). It must include breaks, individual course segments, guided discussion, and activities, where applicable. (Meals, registrations, breaks, business meetings, Q&A, facility tours, award presentations, and other similar events are not eligible for credit.)
Course Length: *
Number of Continuing Education credits requested: *
(One credit for each hour of course work.)
Please describe registration process for potential attendees: *
Course Delivery Method(s)
Indicate Workshop Type: *

Live Workshop or Seminar Video or Audio Conference (Must include a copy of your entire program for review.) Webinar, Web enhanced presentation and discussion (Must include a copy of your entire program for review, in addition to Distance Education supplementary materials.)
Course Objectives
List specific, clear, and concise learning objectives and/or outcomes for the course that are both behavioral and measurable: *
Course Content

(Include a bibliography or reference list in the space provided below. If located in presenter resume, please copy and paste that information in the space provided below.)
List current references (within the past 5 years) as evidence of supporting research (bibliography): *
Bibliography must be in APA format and at least half of the references must be current sources within the last 5 years.
Describe how course content reflects current (within the last 5 years) literature, materials and references and how it relates to one or more of the social work educational areas as listed in guidelines: *
Indicate the type of credits you are requesting: *

Clinical (One of the presenters MUST have a clinical license.) Non-clinical Clinical & Ethics Non-clinical & Ethics Clinical & Social and Cultural Competence Non-clinical & Social and Cultural Competence Prescription Opioid
Identify and explain the skill levels (beginning, intermediate or advanced) targeted by this program. Please be specific. *
Evaluation

(Please be sure your participant evaluation includes items specified by the Application Guidelines for each type of course.)
Please include a copy of your evaluation, in accordance with guideline specifications: *

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Records & Attendance
Please include a copy of your sample certificate, in accordance with guideline specifications: *

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Please include a copy of your sample sign-in sheet, in accordance with guideline specifications: *

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Promotion & Advertising
Please include a copy of ALL course promotional materials, in accordance with guideline specifications: *

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If there are multiple files, additional uploads can be made in the Appendix section below. Cancel of
Complaints/Grievances
Describe your process for responding to complaints and/or grievances from participants regarding course content: *
Describe your process for responding to refund requests: *
Appendix

Provide any additional supporting material for your proposal here. Be sure to clearly number and label according to the section it supports. Please also ensure that all items are in order as they appear in the application.
Appendix Upload 1:

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Appendix Upload 2:

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Appendix Upload 3:

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Appendix Upload 4:

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CE Approval Collaborative Agreement
Please indicate agreement with a check placed on line next to each item. *

I understand that the information in this document will remain confidential, subject to disclosure within The CE Approval Collaborative, upon request, necessary to comply with assessment criteria. I certify that the information provided herein is accurate and, if approved, I agree to abide by all the criteria outlined in this application. I understand that the payment is non-refundable. Should this course be approved, approval is valid for the biennial licensing period in which it was submitted. If this was submitted after March 31 of an even year, approval will extend to the next licensing cycle as well. During an approval time period, the approved course can be offered an unlimited number of times as long as there are no presenter or content changes (this does not apply to those submitted as conferences). I understand that should I wish to offer the course following the expiration of an initial approval, I must submit a renewal application indicating that there are no content changes and pay the current renewal fee. Renewal is only allowed once, after that an application must be submitted again in full. I have read and approved this application, and verify that the information provided herein is accurate, consistent with social work ethical conduct and core values as defined in the “Explanation of Terms.”
Name of Applicant: *
If approved, your program will be listed on our approved listing. Provide the website address or contact email you wish people to use to get in touch with you:

My Products *

Individual or Non-Profit Application $ 150.00

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Non-Profit Conference Rate Free

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For-Profit Conference Rate Free

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Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Reviewer Results

For staff use only. If you are finished with the application, please click Submit above.
Application Status

Approved Approved conditionally Denied
Approval Date

Month Day Year
Date
Approval #:
Credits Approved:
Should be Empty:

NEW JERSEY SOCIAL WORK CONTINUING EDUCATION APPROVAL COLLABORATIVE

CE Approval Collaborative - Course Approval Application Form

Contact Information

Presenter(s)

Course Overview

Course Delivery Method(s)

Course Objectives

Course Content

Evaluation

Records & Attendance

Promotion & Advertising

Complaints/Grievances

Appendix

CE Approval Collaborative Agreement

Reviewer Results