ARIZONA PSYCHOLOGICAL ASSOCIATION (AzPA)
PROGRAM PROPOSAL FOR CONTINUING EDUCATION CO-SPONSORSHIP
Arizona Psychological Association • 4015 S. McClintock Dr., Ste. 110 • Tempe, AZ 85282

(480) 675-9477 • FAX (480) 675-9320

AzPA co–sponsorship indicates that the program offered is considered to have met criteria for continuing education activities as defined by the American Psychological Association.

Continuing education in psychology consists of planned educational activities intended to further education and training of psychologists for the enhancement of psychological practice, education, administration, and research.

Continuing education program co–sponsorship is provided only for a specific activity or program.It does not indicate endorsement of any organization by AzPA.Unless specified in a written agreement, it also does not involve any financial obligation for AzPA. AzPA reserves the right to not co–sponsorany given program.

Program Information

APPLICANT NAME
ORGANIZATION
TITLE & DATE(S) OF PROGRAM
ADDRESS OF EVENT
# CREDITS REQUESTED
PRESENTER(S)
CO-SPONSOR CONTACT
CO-SPONSOR ADDRESS
CO-SPONSOR PHONE
CO-SPONSOR EMAIL
CO-SPONSOR WEBSITE
TARGET AUDIENCE /  Psychologists  Social Workers
 Marriage & Family Therapists  Students
 Mental Health Counselors  Other
LEVEL OF PROGRAM /  Elementary  Intermediate  Advanced
PROGRAM DELIVERY FORMAT /  Classroom (in person)  eTraining/Homestudy  Other – Please specify
NOTE: Speakers must include in their handouts/presentation a statement describing the accuracy and utility of the materials presented, the basis of such statements, the limitations of the content being taught, and the severe and the most common risks, including contradictory evidence and its source.

Program Description

Program Disclaimer:Presenters must include statements that describe the accuracy and utility of the materials presented, the basis of such statements, the limitations of the content being taught, and the severe and the most common risks.
  • SAMPLE:This seminar is geared toward professionals who have little to no experience with mental health applications in the correctional environment. Trust me when I say, it is a very strange place to be a mental health practitioner. The rules of the institution prevail, and you must be very careful in navigating how to practice your craft. I have found that through my experiences, which are going to make-up a substantial proportion of this seminar, that when you are a mental health practitioner in the correctional environment, you are working against time, you are working against many oppositional forces, not the least of which, are the inmates/patients. There are many individuals who have roles to play in the correctional environment, such as wardens, officers/guards, other health care professionals, and criminal investigators, just to name a few, and they can all be sources of difficulty in treating the patient. Also, please be aware, that although what I’m presenting on today is the strength of my experience, I hope I don’t come across as the expert exemplar of correctional mental health. I am not. But hopefully my experiences in working as both a staff psychologist, and now as a mental health manager/chief psychologist, I can provide you with a fairly thorough background on how mental health practice might function in such a seemingly counterproductive environment.

Learning Objectives (3 Minimum)

Writing Behavioral Learning Objectives and Assessments
Learning objectives, or learning outcomes, are statements that clearly describe what the learner will know or be able to do as a result of having attended an educational program or activity.
Learning objectives must be observable and measurable.
Learning objectives should (1) focus on the learner, and (2) contain action verbs that describe measurable behaviors.
Verbs to consider when writing learning objectives
list, describe, recite, write
compute, discuss, explain, predict
apply, demonstrate, prepare, use
analyze, design, select, utilize
compile, create, plan, revise
assess, compare, rate, critique
Verbs to avoid when writing learning objectives
know, understand
learn, appreciate
become aware of, become familiar with
Example of well-written learning objectives
This workshop is designed to help you:
1. Summarize basic hypnosis theory and technique
2. Observe demonstrations of hypnotic technique and phenomena
3. Recognize differences between acute and chronic pain
1)
2)
3)
4)
5)

References/Citations

Please complete the following information:
1) Specified Criterion
2) Brief Narrative – (Providing Justification for the criterion)
3) References (minimum of 5, no older than 7 years)
4) Diversity Statement
SPECIFIED CRITERION: Please check the one most relevant box and provide a brief narrative.
□ Program content focuses on application of psychological assessment and/or intervention methods that have overall consistent and credible empirical support in the contemporary peer reviewed scientific literature beyond those publications and other types of communications devoted primarily to the promotion of the approach.
□ Program content focuses on ethical, legal, statutory or regulatory policies, guidelines, and standards that impact psychological practice, education, or research
□ Program content focuses on topics related to psychological practice, education, or researchother than application of psychological assessment and/or intervention methods that are supported by contemporary scholarship grounded in established research procedures.
BRIEF NARRATIVE – (Providing Justification)
Speakers must briefly describe how the program content meets the specified above criterion, providing relevant references or up to 5 representative citations (where applicable).
REFERENCE:
Program references (must include a minimum of 5 in APA format). Note: References must not be older than 7 years.
1)
2)
3)
4)
5)
DIVERSITY STATEMENT:
Describe how your program reflects attention to diversity in its content and the application of concepts presented. Diversity includes culture, gender and sexual orientation, racial, ethnic, disability, age, religion or socioeconomic differences

Draft Registration Announcement/Brochure Must Accompany Application

All program brochures/announcements or website must include:
  1. Co-Sponsorship logo and statement to read - “This program is co-sponsored by the Arizona Psychological Association (AzPA). AzPA is approved by the American Psychological Association to sponsor continuing education for psychologists. AzPA maintains responsibility for this program and its content.”NOTE: The APA approved sponsor logo must be included in all promotional materials including electronic.
  2. Cancellation policy
  3. Special accommodations information
  4. A website or email address for more information or attendee questions
  5. Program description with learning objectives
  6. Brief speaker bios
  7. Number of CE credits
  8. A description, if applicable, of any commercial support for the CE program, presentation or instructor must be disclosed to program participants at the time the CE program begins. Any other relationship that could be reasonably construed as a conflict of interest also must be disclosed.
  9. A website link or contact information for additional questions regarding the program.

Proposal submission check list

Completed application
Presenter(s) Vita
Learning objectives stated
Program evaluation form. Note: Evaluations must include
How much did you learn as a result of the CE program? (1-very little to 5 being a great deal) / 5 / 4 / 3 / 2 / 1
This presentation included learning materials and interventions, which addressed culture, gender, racial, ethnic and socioeconomic differences. / 5 / 4 / 3 / 2 / 1
Program description included
Academic references/citations included
Draft announcement/brochure to include
Agenda
Co-sponsorship statement
Cancellation policy
Special accommodations contact
Learning objectives
Audience level
Continuing education credits
Fees:
  • The Arizona Psychological Association assesses a non-refundable fee for co-sponsoring continuing education programs. The fee for a program is $250.00 per year. Applications received less than 60 days prior to the event will be assessed an additional $100 fee. Homestudy programs have an annual fee. AzPA will notify the homestudy applicant of yearly renewal fees and due dates. Agreements will be reviewed on a 12-month basis. For more information, contact AzPA office.
  • In addition to the application fee, there is a $10.00/participant charge for AzPA to issue continuing
Education certificates to the participants. Continuing education certificates will not be prepared until
the fees are received by AzPA. In addition, homestudy CE certificates will not be prepared until post-test exam with 90% or above passing is provided. For more information about the homestudy CE participant certificate charge, please contact the AzPA office.
If a sponsoring association establishes a discounted registration fee for its members to attend the program,
AzPA expects the same discount to be made available to AzPA members.
Application must be received 60 days prior to the event
Required Reporting
A report containing a narrative summary of information obtained from the program evaluation must be prepared and sent to AzPA within thirty days following the program. This report must include:
•A narrative summary of the evaluation forms
•A statistical report containing the total number of participants and the percentage of attendees who were psychologists
•A list of participants requesting continuing education certificates
•Copies of the final brochure (electronic and hard copy)
General Guidelines
1. The proposed program must be planned, coordinated, administered, and evaluated in terms of specific educational objectives and designed for a defined group of psychologists. Educational objectives should be expressed in behavioral terms with the specific outcomes expected of each objective clearly stated.
2. Contact with AzPA in the early stages of planning (at least ninety days before the event is scheduled) is suggested. Programs must be submitted to the committee for review/approval prior to the publication of the brochure for the event.The AzPA Continuing Education Coordinator can be of assistance. A format that includes active learner participation is encouraged.
3. For in-person events audio-visual materials used are to supplement the program and should relate to the program design and not be the sole or primary content.
4. Faculty/instructors of co-sponsored programs are expected to be recognized professionals or experts from the fields of psychology, and in approved instances, medicine, social work, behavioral science, law, nursing, and counseling. Per the requirements of the Arizona Board of Psychologist Examiners, faculty/instructors must be appropriately licensed or certified in their field of expertise.
5. Facilities, materials and online learning management systems must be chosen with consideration of sensitivity to and compliance with ethical principles of non–discrimination, individual differences, and confidentiality. Facilities and programs must be accessible for persons with disabilities.
6. Program activities that are potentially stressful or upsetting to participants must be so clarified prior to participant enrollment or attendance. Similarly, if confidential material is to be presented, a statement to that effect, including the limits of confidentiality, must be made at the beginning of the program.
7. Evaluation of the program by participants and faculty must be planned and administered by the program designers of the organization applying for co-sponsorship. The purpose of evaluation is to assist program offerers in determining how well the program met its objectives and what improvements, if any, could be made in the educational design of future offerings. Homestudy programs must create a post-test exam which participants who receive credit must complete with a 90% passing score.
8. The initiating organization is responsible to document attendance of participants by attendance rosters or sign-in sheets. Psychologists and other participants are expectedto maintain their own records of CE activities. AzPA retains office records of all CE events offered or co-sponsored for a period of onlythree years after the date of the program.
9. Homestudy programs must ensure participants complete a registration inclusive of license number (if applicable) and personal identification information. In addition, participants using web-based learning must enter the learning management system through use of an individualized identification log-in and password.
10. Homestudy programs must ensure they have 1 hour of learning activities per 1 hour of CE credit offered.
If you need further clarification, please contact Kate Gagne at the AzPA office, (480) 675-9477.