Continuing Education Provider Application Form
If you have reviewed the ADACBGA’s Educational Provider Standards and wish to apply for approval as a Continuing Education Provider, please complete the below form.
Along with the submission of this form, you must upload a PDF file that includes a listing of the following related to ALL courses for which you are seeking approval:
- Course/Workshop Title(s)
- Date(s) each Course(s)/Workshop(s) are being offered
- Location of the Course(s)/Workshop(s)
- Approved Format of the Course(s)/Workshop(s):
- face-to-face in-person
- live face-to-face videoconference, or
- asynchronous interactive
- Not less than three (3) measurable objectives for each Course/Workshop related to the 12 Core Functions of the A&D Counselor, Professional & Ethical Responsibilities, or the Performance Domains of the Clinical Supervisor, or Peer Recovery Specialist, depending on the topic of the Workshop.
- A short narrative description for each Course/Workshop.
- The full name, contact information, and credentials of each presenter/instructor.
- A current, up-to-date Curriculum Vitae for each presenter/instructor.
- If an asynchronous course offering, a description of how the course will be interactive and the presenter/instructor available for questions before, during, and/or after the Course/Workshop should be included.
- Asynchronous interactive course(s)/workshop(s) must include a scored, competency-based evaluation/quiz after the completion of the training in addition to the overall workshop evaluation.