2008RENEWAL Documentation Form

Please visit the RENEWALCENTER at the Members Only website: for online renewals, downloadable forms, and a listing of addiction training and continuing education opportunities.

The annual renewal of the CAS certification requires a completed CEU form demonstrating successful completion of 20 hours of continuing education hours. The form must be mailed by the anniversary of CAS certification each year, include the renewal fee, and signed 2008 Code of Ethicsform. After due date, late fees apply, unless a written extension request has been approved by the Academy prior to renewaldate. The certification will be considered expired if not received within 90 days of the renewal due date. Renewal information should be mailed to: 314 West Superior St, Ste 508,Duluth, MN55802.

NAME______CAS No. C-______Code of Ethics ______

CERTIFICATES OF ATTENDANCE MUST BE SUBMITTED WITH THIS FORM

Program/Class / Date / Sponsor / Approved By / Location / Hours
Total Hours Submitted For Current Renewal Year:

POLICYON CONTINUING EDUCATION: The Trustees of the AmericanAcademy of Health Care Providers in the Addictive Disorders have determined that each member of the Academy must document ANNUALLY a minimum of 20 hours of continuing education to keep their certification current. Continuing education programs accepted by the Academy are those programs approved by the following organizations: Alcohol & Drug Problems Assn.; American Assn. of Marriage & Family Therapists; American Assn. of Sex Educators, Counselors, and Therapists; AMA; American Nursing Assn.; APA; ASAM; Employee Assistance Professionals Assn.; International Assn. of Eating Disorder Professionals; NAADAC; NASW; National Assn. of State Alcohol & Drug Abuse Directors; International Certification Reciprocity Consortium; American Methadone Treatment Assn.; National Treatment Consortium; Therapeutic Communities of America; all addiction-related programs approved by state certifying boards, subject to the American Academy of Health Care Providers in the Addiction Disorders Renewal Requirements. For further information, please contact the AmericanAcademy, 314 West Superior Street, Suite 508, Duluth, MN55802, 218-727-3940,

2008RENEWAL Documentation Form

CERTIFICATES OF ATTENDANCE MUST BE SUBMITTED WITH THIS FORM

Continual changes in the field of addictions require that Academy members be committed to lifelong learning by maintaining an awareness of research findings, changes in treatment techniques and therapeutic approaches. The Academy’s 20-hour continuing education annual requirement is designed to ensure that our members are well-informed about contemporary addictions research and treatment information.

  1. All continuing education hours must be addiction-related coursework.
  2. The Academy will not accept coursework that has been completed more than one year prior to your annual renewal date.
  3. The coursework must be approved by a state or national accrediting body. The Academy provides a partial list of accepted accrediting organizations on the bottom of its Continuing Education Documentation form. If the coursework has not been approved by an agency, then you must contact the Academy for approval.
  4. Coursework must be documented by a certificate of attendance on the agency’s letterhead listing the attendee, the approved CEU hours, the dates of attendance, the approval body and signature of the presenter.
  5. The Academy will accept teaching hours provided that the instruction took place at a college level. Teaching hours apply to one presentation only and they are calculated at 50% of their value.
  6. Clinical supervision hours and/or hours associated with employment responsibilities are not acceptable.
  7. Continuing education hours may only carry forward for one year.
  8. The Academy reserves the right to disallow entries if they do not meet requirements as set forth.
  9. Extensions must be requested prior to the renewal date.
  10. Code of Ethics form signed with annual renewal.
  11. Late fees apply to all of the above if not completed by the renewal date.

NAME:______CAS No. C-______Day telephone number where I can be reached: (___)______

Email address:______

PERSONAL:

______Send correspondence to:

Personal Address City State Zip Code

(____)______(____)______(____)______□ Personal Address

Personal Phone Cell PhoneFax No.

PROFESSIONAL:

______□ Professional Address

Name of Program or Practice

______

Professional AddressCityStateZip Code

(____)______(____)______

Business PhoneFax No. 9/2008