MISSISSIPPI BOARD OF PSYCHOLOGY
Continuing Professional Education
CE Reporting Form - July 1, 2015 to June 30, 2017
CONTINUING EDUCATION
This is a reporting year for your professional continuing education activities for the last two years and you will need to submit a completed biennial report form. The reporting period is from July 1, 2015 through June 30. 2017. You must report a minimum of 20 approved contact hours, two (2) of which must be in the area of ethics or legal issues and these must have occurred during the reporting period.
The Board limits acceptable CE hours to those offered by providers who are approved by the American Psychological Association or Board-approved providers within the state of Mississippi. These providers must meet standards that guarantee the quality and appropriateness of the programs they offer. The Board is aware that there are many professional education experiences and programs that are of excellent quality and appropriateness, even though they might not be sponsored by an APA- or Board-approved provider. Accordingly, there are two options for the use of CE hours from a provider without APA or Board approval:
1. If you attended a psychological or inter-professional conference or training program lasting one full day or longer and directly related to the practice of psychology not offered by APA or Board-approved providers, the Board will accept three (3) clock hours for each such conference or training program. During a biennial reporting period, the Board will accept a maximum of twelve (12) clock hours for such conferences.
OR
2. Full credit of continuing education activities that are not provided by an APA or Board approved provider will not be accepted unless you have requested prior approval. The request must have been received in sufficient time, preferably two months or more before the event, for the Board to review the program for content and appropriateness.
There are two exceptions or modifications related to reporting continuing education activities:
1. If your license was issued after July 1, 2016, you do not need to report your continuing education activities at this time.
2. If you have been licensed for at least one full year, but less than two year (after July 1, 2015 and before June 30, 2016), you are required to report ten (10) approved contact hours and one (1) hour of ethical or legal issues.
Continuing education activities are subject to a random audit by the Board. Therefore, be sure to retain a copy of your reporting form along with your certificates, registration receipts, or other forms of documentation, as such proof will be required in the event of an audit. DO NOT SUBMIT DOCUMENTATION OTHER THAN THE CE REPORT FORM AT THIS TIME. If you are selected by the Board from a random audit you will receive notification from the Board with instruction on the documentation this is acceptable.
INSTRUCTIONS:
1. This is a Microsoft Word™ fillable form; type or paste information into the appropriate field. Use another copy of this form if necessary.
2. Please enter the full title of the CE activity.
3. Enter the full name of the CE sponsor (no abbreviations). Please note that the actual sponsor of the CE activity is sometimes different from the host of the event. The CE sponsor is clearly identified on the activity completion certificate.
4. Indicate if the CE sponsor is approved by the American Psychological Association (APA) or the MS Board of Psychology (MSBP); if not, leave blank.
5. Check the box to indicate that the CE activity content was directly and substantially related to professional ethics or legal issues in the delivery of psychological services. List all ethics/legal CE credits separately. Example: if the CE activity provides 6 (six) clock hours credit that includes 1 (one) clock hour of ethics/legal credit, report the net 5 (five) clock hours separately from the 1 (one) clock hour of ethics/legal credit.
6. Enter the number of clock hours for the CE activity.
MISSISSIPPI BOARD OF PSYCHOLOGY
Continuing Professional Education
CE Reporting Form - July 1, 2015 to June 30, 2017
Name: / License Number: / Page / ofDate
/Title of CE Activity
/ Name of CE Sponsor(s) / CE Provider ApprovalStatus: (APA or MSBP) / Mark if Ethics or Legal credit / Number
of Contact Hours
By my written or typed signature below I certify that the above information is correct and meets the criteria of acceptability according to rules 12.3 and 12.6 of The Rules And Regulations of the Mississippi Board Of Psychology.
Total Hours, this page
Ethics/Legal Hours, this page
Signature: