Form Test

Contact Person*

This is the person who, should you choose to have the training event posted on the Board's website, will be listed as the contact for people who want to sign up for the training event.

Sponsor Organization*

Contact Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Phone*

This is the phone number that, should you choose to have the training event posted on the Board's website, will be listed as the contact number for people who want to sign up for the training.

Contact Email*

This is the email address where the approval information will be sent. If you elect to have your event posted on the Board's website, it will also be listed there as the contact email for people who want to sign up for the training.

Title of Training*

Please enter the entire title of the training course. If you elect to have your event posted on the Board's website, it will be posted under the title entered here.

Date(s) of Training*

Please enter all dates on which the training will be presented. If this is an ongoing training with no specific dates scheduled, or is an online / self-study training, please note that here as well.

Posted/Advertised on Board’s Website Training Page*

Yes

Check yes for the training to be added to the listing of Board-approved training events available on the website. There is no additional fee for this.

*** In order to guarantee the training will be posted prior to when it occurs, please adhere to the "submit 45 days in advance" guideline. ***

Location and/or Website*

If this is an in-person training event, please enter the city/town where the training will occur. If this will be a live, interactive webinar or traditional "click-thru" online course, please enter the web address/link for participants to use to register for (or access information about) the training.

Presenter

*****PLEASE READ BEFORE CONTINUING WITH PRESENTER SECTION*****

IF YOUR PRESENTER IS CREDENTIALED WITH THE NCASPPB, you will select "Other" in the drop-down menu and enter their name in the "Alternate Presenter" box. You do NOT need to submit their resume as it is already on file with the Board.

IF YOUR PRESENTER IS NOT CREDENTIALED WITH THE NCASPPB, check the drop-down list (which is a list of presenters with a resume already on file with the Board from a prior Training Approval Request.) If their name IS ON THE LIST, select their name. You do NOT need to submit their resume. There is a maximum of 3 names that can be selected from the drop-down list. If their name is NOT ON THE LIST, select "Other" in the drop-down menu and enter their name in the "Alternate Presenter" box. You WILL need to upload their resume/CV/bio in the "Presenter Resume(s)" Section.

Multiple Presenters?

Yes

No

Presenter
Choose Additional Presenter

Alternate Presenter(s)
Presenter Name(s)

Presenter Resume(s)

Drop files here or

Accepted file types: doc, docx, pdf, ppt, pptx, Max. file size: 100 MB, Max. files: 10.

Please upload a resume/bio/CV for each presenter listed above who is not in the drop-down menu or credentialed with the Board. There is a maximum of 10 documents that can be uploaded. If you have additional documents, please submit them via email to Donna Strickland. and include the title of the training for which they are presenting.

Description of Training and Agenda

Drop files here or

Accepted file types: doc, docx, pdf, ppt, pptx, Max. file size: 100 MB, Max. files: 10.

Please upload a course description and agenda for the training. For in-person training and webinars, if the training is longer than two hours, the agenda needs to be broken down by time and topic. For online courses, please submit documentation of course content and presentation. There is a maximum of 10 documents that can be uploaded. If you have additional documents, please submit them via email to Donna Strickland. and include the title of the training to which they correspond.
For self-study trainings, please make sure to include the mechanism of evaluation which is in place to assure the attendees completed the entire training.

Total Number of Hours Requested*
Please enter a number greater than or equal to 0.

Type of Hours Requested*
Substance Use Disorder Specific (SS)
General Skill Building (SB)

Specialty Hours Requested*
N/A
Clinical Supervision (CSS)
Ethics (ETHICS)
Evidence-Based Treatment (EBT)
HIV/AIDS/BBP/STD/TB (HIV)
Nicotine Dependence (ND)
Psychopathology (PSY)
Substance Use Disorder and Domestic Violence (DV)
Substance Use Disorder and the Elderly (SUDE - formerly SAOA)
Substance Use Disorder and Veterans (SUDV - formerly SAV)

Fee Schedule

The annual fee shall be as follows:

1-10 hours - $25

10-20 hours - $50

20-30 hours - $75

30-40 hours - $100

40 hours & up - $125

Thank you for completing a NCASPPB training approval request. You will receive an email once the course has been reviewed.

Fee Schedule

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