Continuing Education Information Sheet
IMPORTANT: YOU MUST COMPLETE ALL SECTIONS (1 thru 8) IN FULL
1. PRIMARY CONTACT PERSON FOR PROGRAM (CHAIR)
Name & Degree:
Mailing address:
City/State/Country/Zip:
Phone:
Fax:
Email:
2. BASIC PRESENTATION INFORMATION
Title of Panel/Presentation:
Name of Conference or Co-Sponsor (If applicable):
Date of Presentation (if known):
Time of Presentation (Beginning & End; if known):
Will there be breaks? If so, time/length of breaks:
Location (if known):
Registration/Participant Cap:
Fee (Please note that it is customary to give TCSPP Faculty, Staff, & Alumni a 50% discount & charge
TCSPP students no more than $25. If this does not work for your event, please let us know as soon as
possible).
What is included in fee (ex. Will food be provided)?
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Refund Policy: CE events normally use the below refund policy, if this does not work for your event,
please provide another policy below..
75% of tuition is refundable up to 7 days before the program. Within 7 days of the program, tuition is
nonrefundable.
3. INSTRUCTIONAL LEVEL OF PROGRAM
What instructional level is this program?
___INTRODUCTORY: No prior knowledge of the specific content area is needed. The information or skills
will be new for those who attend.
___INTERMEDIATE: Some basic knowledge of the specific content area is required, but you need
not have in-depth knowledge or skills. The panel will provide information at a level beyond the basic
knowledge of the topic.
___ADVANCED: You should have substantial working knowledge or skill in the specific content area. At
this level, advanced technique or knowledge is offered to refine and expand current expertise.
Target Audience (example: psychologists, LCSWs, MFTs, LCPCs, all mental health disciplines, etc.):
4. BRIEF DESCRIPTION (Short Paragraph): Brief description of program/presentation, including
instructional level. Begin your description with, for example, “This introductory (or intermediate or
advanced) presentation…”
BRIEF DESCRIPTION (TYPE/WRITE HERE) (attach add’l sheets if needed):
5. LEARNING OBJECTIVES
One learning objective is required per hour of CE credit (e.g., 3 CE Credits = 3 Learning Objectives)
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(see pages 6-7 of this document for details on APA’s standards for learning objectives)
1.
2.
3.
4.
5.
6. FACULTY
In addition to completing the information below, a CV is required for each presenter. Also include a
picture if possible (this will be used on advertisements).
PRESENTER # 1: Name, degree, discipline, and current professional position
Short Presenter Bio and Explanation of Expertise in program content:
PRESENTER #2 (if applicable): Name, degree, discipline, and current professional position
Short Presenter Bio and Explanation of Expertise in program content:
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(Add additional presenters if needed)
7. REFERENCES
Please list 3-6 complete references in APA format from the literature that supports the
scientific/professional basis of the content to be presented.
One learning objective is required per hour of CE credit (e.g., 3 CE Credits = 3 References)
1.
2.
3.
4.
5.
8. ANSWER THE FOLLOWING QUESTIONS:
A. Any commercial support for this program’s presenters?
□YES □NO
B. Any commercial support for content discussed?
□YES □NO
C. Any commercial support for products/services discussed?
□YES □NO
D. Any relationships between presenter, Division 39, program content, research, grants or other funding
sources that could reasonably be construed as conflicts of interest? □YES
□NO
Please explain any “Yes” responses to the above questions:
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_____________________________________________________________________________________
_____________________________________________________________________________________
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Instructor’s Agreement
By agreeing to present a continuing education activity, presenters commit to the following:
●Presenters should be familiar with the ethical principles established in the American Psychological
Association’s Ethical Principles for Psychologists, a copy of which will be furnished upon request.
●Presenters must respect the need for privacy and confidentiality throughout the program and assume
responsibility for reminding participants of this, as needed.
●Presenters must anticipate the possibility of stress related to program content and to allow time for
participants to process these feelings should the need arise.
●Presenters will offer information on the scientific or professional basis of the content presented. This
is to include the validity and utility of the content and associated materials, the basis of such statements
about validity/utility, and the limitations of and risks (severe and most common) associated with the
content, if any. This can be done through references that support the content from the scientific or
professional literature and/or through the program learning objectives and/or verbally during the
activity.
●Presenters must disclose any commercial support (for the program, presenter, or product reviewed)
and any other relationship that could reasonably be construed as a conflict of interest.
Instructor/Presenter’s Signature (typed signatures are allowed):
X
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Writing Behavioral Learning Objectives
(from the American Psychological Association’s Standards and Guidelines for continuing education)
The successful design of programs to be offered for continuing education credit requires careful
planning of the educational objectives that identify what prospective participants will learn. These
learning objectives should be available to prospective participants before registration for the event and
must be stated in measurable terms with action verbs that focus on the participant/learner’s abilities.
●Rather than describing topics to be covered, learning objectives or outcomes are statements that
clearly define what the participant will know or be able to do as a result of having attended the
program.
●Learning objectives must be observable and measurable.
●Learning objectives should (1) focus on the learner, and (2) contain action verbs that describe
measurable behaviors.
●As a guideline, programs should have one learning objective for each hour of learning time.
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
Distinguishing Insufficient and Sufficient Learning Objectives:
For a program entitled, “Succeeding in an Academic Career,” the following are INSUFFICIENT LEARNING
OBJECTIVES which
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DO NOT meet the APA’s criteria:
At the conclusion of this program, participants will be able to:
1. Identify the advantages in advancing one’s career of having a systematic research program.
2. Manage the complexities of scheduling research assistants, supervisees and other helpers.
3. Negotiate the ins and outs of getting publications and grants.
4. Discharge advising obligations while still having time to write.
5. Increase chances for retention, tenure, and promotion through understanding academic policies and
the administrative structure.
The learning objectives listed here, however, are ACCEPTABLE, SUFFICIENT and DO meet the APA’s
criteria:
At the conclusion of this program, participants will be able to:
1. Identify the practical applications for teaching effectiveness of building a systematic research
program.
2. Identify relevant ethical codes associated with research, clinical, or academic supervision with
students.
3. Negotiate the regulatory and ethical information regarding publication and grant writing with
colleagues or students.
4. Apply appropriate mentoring skills for maximal student growth.
5. Use an understanding of academic policies and the administrative structure to create more efficient
classrooms and labs.
Note: Insufficient learning objectives identify the advantages that might accrue to the individual faculty
member, but fail to link these to improved services and the broader regulatory, ethical or professional
issues that might also serve broader constituents within this context. By contrast, the acceptable
learning objectives effectively tie the knowledge gains associated with this program to the effective
functioning of the students and the administrative units associated with the faculty’s functioning, and
highlight the professional and scientific gains that would be expected to accrue as a result of the
program.
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