SendCheckand Application Envelope to:
NationalAssociatiooof SchoolPsychologists
c/o SunTrust
P.O.Box 79469
Ballimo.e,MD 22 l7 9 -M69
Inq iries to:
NASP Professional
Standads
(30t) 657-0270 FAX: (301)657-0275
E-Mail: cert@naspweb.org
NASP
APPROVED PROVIDER OF CONTINUING PROFESSIONAI DEVELOPMENT
INITIAL APPLICATION
Instructions: Pleaseprint or type,and completeall items. Ifadditional spaceis needed,useadditionalsheetsproperlymarked
with theconespondingsectionof theapplication.Enclosefive copiesof the completedapplicationpacketin a sealedenvelope
marked"ApprovedProviderApplication-" Placethat envclope,alongwith your checkmadepayableto NASP, insidea larger
envelopeandmail both to the addressabove(seeaccompanyinginstructions).
Nameof OreanizatioMndividual
Nameof ContinuingEducationD ector(unlessothenvisedesignated,this individualwill serveastheNASP contact):
':25
Address
NoRTH
Wi:)/ S
ST
IL
DaytimeTelephone
3lA . 3: 1. 6e>oE-Mail
Fax
Directorof Organization(if differentfiom above)
!vtc(S
Application Checklist: Pleaselabelall attachments
clearly. Prinr or typeall attachment
forms.
Non-refundable
application
fee
-!l
NASP-afiiliatedstateschoolpsychologyassociations
($200)
y'
'D program
[or threepreviouslyofferedprograms(AttachmentA)
one pendingprogram(AttachmentB)
A.tiachment
C)
Summariesof evaluationscompletedby participantsof threepreviouslyoffe.edprograms
I certify.that the information provided herein is accurate. I agreeto ebide by the NASP P/izcrbleJfor ProlessionalEthics in
regard to aheoffering ofactivities, and to comply wiah aherequirementsset forth in thir applicstion packet.
TheNational Association of School Pslchologisls (NASP)values diversity. Therewill be no barriers lo approval on the basisof
gender, race, creed, age, sexual orientation, or national origin.
NASP USE ONLY
DateReceived
ProviderNumber
FeePaid
Effective Date
CheckNumber
Applicrtion - NASP Approved Provider OfContinuing Prof$sioorl Development
P,,ge2
A. Gosls rnd Objectives
L Describeyour organization'soverallfunctionsandgoals.
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2. Bdefly statethe specificgoalsofyour continuingeducationprogramfor schoolpsychologists,
indicatinghow theserelateto the
overallgoalsof your organization.
TH€ kaAL
0F o\rR. CoNrrN\r"rjk -E-pUa\n or.l PRoqR
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3. Descdbethe targetaudience(educationlevel andprofession)to which you directyour continuingeducationactivities.
CERTIFIED Scno0r- ?e\ctowqg19
ttl qrEkToR c.tc,\qoLt+t\)DAREA.
4. Checkanyprofessionalcertificationor licensurebodiesby which your organizationis currentlyapprovedto offer continuing
educationactivities.
_
_
_
_
-
AmericanPsychological
Association
NationalBoardfor CertifiedCounselors
AmericanMedicalAssociation
SateDepartmentof Education(indicatestate:
StatePsychology Licensing Board (state:
Others(pleaselist)
Lf (EuEEtr PRoFrgstor.hrrouNs,qrR cLtN iu,)- our,.(EL0R
c
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. I,tARAtAEt.r\l\tD
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Whendid your organizationbeginofferin!
pslbhologisii?
continuirigbducationactivitiesto schbol
Whatis the averagenumberofcontinuing educationactivitiesthat you offer per calendaryear?
What is the approximatenumberofparticipanlsat eachacrivity? ./-l
Pleas-e
indiciie-ihelbar:
/J
,
TheChicagoSchoolofProfessionalPsychology- MissionDocuments
Page1 of2
The0hicaeoSchool
eT{}
Psychology
ol Profcssioi-al
-V'
Home> Aboul > MissionDocuments
MissionDocuments
Vision
psychology
The ChicagoSchoolstrivesto be the schoolof choicein professional
and to realizeits missionthroughinnovation
andquality.
Mission
practice,and innovation,
Integrating
theory,professional
The ChicagoSchoolof Professional
Psychologyprovidesan excellent
educationfor careersin psychologyand relaledbehavioraland healthsciences.The schoolis committedto serviceand
embracesthe diversecommunities
ofour societv.
Values
Reflecting
the systemicintegration
ofour mission,our logosymbolizesour values:Education;Innovation;
Service;and
Community.
Philosophy
TheChicagoSchooleducatesprofessionals
whosepracticesexemplifya commitmentto understand
and respectindividualand
judgmentis achievedlhroughthe integration
culturaldifferences.
The application
of humaneprofessional
of psychological
practice.The curriculumand trainingopportunities
theory,scientiflcresearch,and professional
preparegraduatesto deliver
professional
outstanding
services,emphasizing
the needto understanddiversityand the importance
of workingwith
populations.
underserved
Fromthisstatementof purpose,we deriveour institutional
goals,whichare attainedthrough
programsof study Our consistent
individual
focuson studentlearningensuresthat the institutionprovidesexcellentcareer
education.
Eachprogramregularlyidentifiesthe learningexpectations,
determinesthe outcomesof thesestudent-learning
expectiations
acrossacademicprograms,and usesassessmentresultslo improvestudentlearning.Our institutional
learning
goalsfor studentscompletingour degreeprogramsare:
Scro/arshrp.
Graduateswill be ableto usescientillcresearchand theoryto Informtheirpractrcesand be ableto prepare
scholarlyworkbroadlydeflned;
Divets,,lty.
Graduateswill be able to applytheoretical
and practicalknowledgeaboutethnic,racial,gender,sexual,culturaland
religious,
age,and disabilitydifferencein theirprofessional
work;
Professional
BehaviorGraduateswill be ableto functionin a professional
and ethicalmanner;
Prclessional
PecticerGraduateswill be ableto conductassessments,
developappropriateinterventions,
and implement
psychology.
interventions
in theirspecialtyareaof professional
StudentFocusedLearning
To insurean effectiveand highqualityeducalionexperience,
The ChicagoSchoolfacultysystematically
monitorsstudent
learningto informfutureplanningand to generatecreative,fesponsiveinitiativesto improvethe programs.Dataare gathered,
analfzed,and presentedto the learningcommunityfor review.Basedon theseresults,the programrevisesthe studentlearning
plan,the curriculum,and the approachto learningin the classroom.Studentlearningassessmentoffersthe school
assessment
a criticalopportunityto evaluatethe effectiveness
of its programsand to developinnovative,
student-focused
learning
http://www.thechicagoschool.edu/common/modulesiprintfriendly/printfriendly.cfm2page=...
312012008
TheChicagoSchoolofProfessionalPsychology- MissionDocuments
Page2 of 2
environments.
To optimizethe learningenvironment
offeredby the pfograms,studentsarestronglyencouragedto be activelearners.Active
sludentlearnersreflecton the conditions
and activitiesthatengagelheir learningstyleand workindependenty,
withpeersand
withfaculty,to enhancetheirlearningin the classroom.
Commitmentto Diversity
TheChicagoSchoolof Professional
Psychology
is committedto beingtheschoolofchoiceby buildingan environment
of
mutualrespectand inclusionwhereall individuals
will be valuedfor who theyare andwhattheycan conkibute,and in turn,are
expectedto be participatory
membersof an activelearningcommunitythatpromotesqllturalawareness,competence,
and
understanding
of diversity.
ProgramInformation
AppliedBehavior
Analysis
ClinicalPsychology
GraduateProgrem
Counseling
Psychology
Gfaduate
Programs
ForensicPsychology
GraduatePrograms
IndustrialOrganizational
and BusinessPsychology
Programs
SchoolPsychology
Continuing
Professional
Education
hltpr/vew-lhechlca9o€ch@l edu/@nlenl.cfi Vmlssion_andjhito6ophy
@2000The ChicagoSchoolol PrcfesslonalPsycholo€y,325 N WettsStreet,Chlcago,tL 60610 312_329.6600
i http://www.thechicagoschool.edu/common/modules/printfriendly/printfriendly.cftn?page=...
312012008
The ChicagoSchool ofProfessional Psychology- School PsychologyEd.S (Chicago)
Page I of2
G.
SDTheChicasoschool
Psycholo8y
of Profcssion-al
5t'
Home> ProgramsSchoolPsychology> SchoolPsychologyEd S (Chicago)
SchoolPsychologyEd.S(Ghicago)
ProgramHighlights
.
Emphasison practltioner-focused
learningin schoolbasedsettings
.
populations;
successful
Highvalueplaced'onthe abilityto workwithand underslanddiverseand oftenunderserved
for andcompetencyin thisarea
studentsdemonstrate
an appreciation
.
for youth
A preventivefocusto discoverhowto enhanceeducational
opportunities
.
in a dynamic
Excellenttheoreticalclassroomtrainingcoupledwith unrivaledout-of-classroom
learningopportunities
urbanenvironment
ProgramObjectives
.
Studentswilllearnthe theoretical
frameworks
and scientificbasesof SchoolPsychology
at the specialistlevel.
.
Studentswill learnto developessentialdiagnostic,therapeutic,
andconsultative
skillsin orderto workwitha varietyof
populations
anda varietyof emotional
andpsychological
conditions
.
To bothapplyempirical
findings
to theirpractice
Students
willlearnresearch
andprogram
evaluation
methodologies.
and examineexistingprogramsfor effectiveness.
.
guidelinesof SchoolPsychology
Studentswill learnthe legal,ethical,and prolessional
.
Studentswill understiand
and appreciatethe impactof diversityand culturalissuesin the lieldof SchoolPsychology.
ProgramRequirements/Expectations
The SchoolPsychologyEd.S.is a full-timeor part-timeprogramrequiring66 credithours.The program,designedto prepare
includes120hoursof servicelearning,480+hoursof practicumtrainingand
studentsfor endorsement
as a schoolpsychologist,
1,200+hoursot internship
(fulltime)in a schoolsetting.
Themaximum
duration
ofthe programis llveyears.
Qualificationsto Apply
.
Bachelor'sdegreefroman accreditedinstitution
.
GPAof 3 2 or higheron a 4.0scaleis required
Generally,
a combined
undergraduate
andgraduate
.
yourapplication
yeta combined
TheGREis notrequired,
verbalandqualitative
scoreof 900or higherwillenhance
o Completionof one coursein statisticsor researchmethods,and at leastone coursein psychology
TOEFLand lntemational Crcdential
youmustsubmitTOEFL
ltyou
lfEnglishis notyourprimarylanguage,
scores(SchoolCode:7161) withyourapplication.
http://www.thechicagoschool.edr:/commor/modules/printfriendly/printfriendly.cfrn?page:...
3/2012008
The ChicagoSchool ofProfessional Psychology- SchoolPsychologyEd.S (Chicago)
Page2 of2
attendor haveattendeda universitythatis not in the UnitedStates,you mustsubmita "course-by-course'
evaluationof your
transcripts.
WorldEducationServicesor Educational
Youcan arrangefor an evaluationthroughseveralorganizations:
Credential
EvaluatorsInc.Studentsmusthavea U.S.equivalentbachelor's
degree.You alsomustsubmitto The Chicago
VisitInternational
Studenls
Schooiall of{icialundergraduate
andgraduatetranscriptsin additionto the agencyevaluation.
Servicespagefor moreinformation.
Certification
TheSchoolPsychologyEd.S.will preparestudentsto takethe Type73 examination
for lllinoisendorsement
as a school
psychologist
(Praxisll) examination
Testing
and the NationallyCertifiedSchoolPsychology
administered
by the Educational
Service.The NationaliyCertifiedSchoolPsychologist
examination
is a requiredcomponentfor one to becomea Nationally
(NCSP).
Certified SchoolPsychologist
Formoreinformation
aboutour SchoolPsychology
specialization
contact:
Officeof Admission
400.721.8072
Email:admissions@thechicagoschool.edu
AdditionalProgramInformatlon
AppliedBehaviorAnalysis
ClinicalPsychology
Counseling
Psychology
ForensicPsychology
IndustdalOrganizational
and BusinessPsychology
SchoolPsychology
Continuing
Professional
Development
hllp/ rww lhechicasGchool.edu/conlent crF schoolpsycholosy_eds_(chicago)
@2008 lhe Chrc€go Sc-llool of Prcles!*oal
Psydolosy, 325 N werls SIleeL Chrc€go, l! 60610 312-329.6600
http://www.thechicagoschool.edu./commor/modules/printfriendly/printfriendly.cfrn?page=...
3120/2008
r lyertur\rEJ
- f\9urE(lttA[l(,ll
ragc I trr z
IheChicasoSchool
o{ Profcssioial
Psychology
Home > About > AcEr€dltatibn
Accreditation
Instjt donal Accrcdltations
CHEA
,dc.edjrod hy a cxEt.rocogi,zdd
ac.rerrun9 dr9rnr!iI0n
PrcgramAcctedltations
The chicagoschool is alsoan aclivememberof the Nationalcouncil
psycrotogy,
of schootsand programsof professional
whichhas recognizedthe schooltorits distinguished
servicaand outstanding
contnbutrons
to culturgldiversity.
OurChicagocampusClinicalpsychologydocloralprogramis accredited
by:
TheAmericanPsychological
Association
Offce of ProgramConsultationand Accreditatjon
750 FilstStEet. NE
Washington,
DC 2OOO24Z42
202.336.5979
The scfiool PsydrotogyEd,s, programis accreditedby the lllinoisstate
Boardof Educa$on(tsBE).
lllinoisStateBoardof Education
Deparfnent of Certification
100Norft FirstStreet,5-306
Springfi
eld, lllinois62777-OO0.t
866.262.6663
Prognm Infomadon
j ' a L r rr
r j : i . a !,n Ar j.r !:j :! r r _: : .r : t v r t fa t! .' G a :i.j:i: F j;r l:-
http://www.thechicagoschool.edu/common/modules/printfriendly/priatfriendly.cfoi?page=...3/20/2OOg
Application - NASP Approved proyider (XConainuing prof€ssionalDeyelopmetrt
P8ge3
B. Adminiltrrtlotr
l Provide the nameand title ofth€ individual who is responsiblefor the managementofthe continuing educationprogram.
Aftach a curent vita for this individuat.
Wi&,aA gnrr
Ifthis individuatdoesnot havea backgroundin schoolpsychology,who overseesthe schoolpsychologycontentofyour
continuins
prosrams?
education
f
.
€lli.
("lr.l^
cl
Attach a curent vita andprovidea descriptionofthis person'squatifications
C. Frcilities
l. Describethefacilitiesin which your orgdization conductsits continuingeducationactivities.
-lhL cs,rnhuz*Jtuafn
acfi)ltq
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2. what accommodationshave been madefor program participants who have physical disabilities or sensoryimpairments?
1b At"aXoS,+nt a^ftes t)4"
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S'.
.
MICHAEL A. BARR" Ph. D.
1758West96* Street
Chicago,Illinois 60643
schoololJice
retephone:
(312)329-6620
E'Mait:
mbarr@thechicagoschool.edu
homeofrce
(312) 504-ZZ0'l
smartbarr@comcast.net
Professional Experience
DIRECTOR. EXECfITIVE AND PROFESSIONAL EDUCATION
The ChicagoSchoolof Professional
Psychology.Chicago,Illinois,March2002to present
o Developandimplementcontinuingeducationprogramming
for licensedpsychology
professionals.
o Developand implementgraduatecertificateprogramsin psychologyandrelatedhealthscience,
to includeonlinecoursesin master'sanddoctoralprograms(bothcreatingandteaching).
. Developand implementleadershipdevelopmentprogramrningfor generalpublic. Trainedover
100leadersbetweenOctober2006andJanuary2008,fromentrylevelto Vice President.
. Developanddelivercustomized
trainingfor corporateclientsbothin personandonline.
o Performdutiesof LeadConsultantfor interdisciplinaryconsultingservicescenter,including
projectsinclude:
IndustriaVOrganizational,
Forensic,andClinicalPrograms.Completed
o Designedanddeliveredcustomized
timemanagement
trainingfor
andcommunications
major interior architecturaldesignfrrm.
o Designedandconducted
exit survey(onlineandstructuredinterviews)for majornational
real estatedeveloper,linking findings ernployeesurveys,tumoverdatato guide
corporateinitiatives.
o Createdanddeliveredcross-cultural
trainingto clinicalcounselors
for theUS Navy Fleet
andFamilyServices.
modeland
o Engagedby majorsoftwaredeveloperto developleadership
competency
leadership
trainingfor all levelsofpersonnelwithintheorganization.
o Developedand conductedthreebiannualemployeesurveyselectronicallyfor global
logisticssoftwaredeveloper,
repoftingresultsin stratifiedreportbooksandin
presentationto ExecutiveCommittee;conductedfollow up focus groupsand provided
assistance
with actionplan development.
o Re-engineered
theprocessfor committeemanagement
at a majormembership-based
professional
organization
responsible
for licensingmedicalprofessionals.
o Createdtraining programfor behavioraltherapistson anxiety disordersfor major nonprofit mentalhealthservicesprovider.
o Providedleadershipcoachingand developmentand a productivity improvementprogram
for a largeadministrativeunit of a major public university.
o Instruct primarily in IndustriaVOrganizational
programand in Clinical programon as-needbasis
for researchmethodsandstatistics(intermediate
andadvanced).
sinceFall 2001.
MANAGING DIRECTOR
Inc. (Organizational
Development
Chicago,Illinois,May 1999to
StrategicResources,
Consultants)
Dresent
I
\rITAE
NAME:
COPEI-AND, ELLIS P.
PRESENTPOSITION:
Professor& Department Chair ofSchool Psychology
ChicagoSchoolof ProfessionalPsycholory
325 N. Wells Street
Chicago,IL 6o6ro
Phone:3rz-329-6684
e-mail: ecopeland@thechicagoschool.edu
HOME:
6z40 S. Grant St.
Burr Ridge,lL6o5z7
Home Phone: 6go-789-t4zs
e-mail: vecopeland@comcast.net
July, zooT
EDUCATION:
Year(s)
Degree
Institution
Area of Study
1988
Post-Doctoral
Family PracticeMedicine
Greeley & Denver, CO
Family Medicine
Health Psychology
1981
Post-Doctoral
Bowman Gray Schoolof
Neuropsychology
Medicine,Winston-Salem,NC
r97S
Ph.D.
Univ. ofTexas at Austin
(NASP&APA accredited)
EducationalPsychology
(Schooland Counseling)
r97o
B.A.
Univ. of Texasat Austin
Psycholory,Math Minor
PRIOR WORK EXPERIENCE:
ProfessionalAcademic
Year(s)
Institution/Organization
Position
Responsibilities
2oo4- 2oo1 BenedictineUniversity
Director of Field-Based
Programs - Education
Administration
1982-1984, Univ. of Northern Colorado
Winter 1986
Coordinator/Director of
School Psychology
Coordinating
Administration
Division Director
Administrator
199o-2oo3 Univ. of Northern Colorado
Professorof
School Psychology
Teaching,Research
Administration
1980-1990 Univ. of Northern Colorado
AssociateProfessor
of School Psychology
Teaching/Research
2OO1-2O03
l991-1997
Univ. of Northern Colorado
Applicstion - NASP Approved Provid€r (XContinuing ProfesslonalDeyelopEert
Prge 4
D. Progrlm Cortent
l. Attachments:
Attachment A: PREVIOUSLY OFFEREDPROGRAMFORM
Attachment B: PENDING PROGRAMFORM
SubmitonePREVIOUSLYOFFEREDPROCRAMFORM for eachofthe threemostrecentcontinuingeducationprograms
that you havc offered AND one PENDING PROGRAM FORM for an activity that you are planning. Attach a
brochure./announcement
for each of the programsthat have already beenoffered. Attach a brochurdannouncement(draft
acceptable)
thependingprogram.
2. Describeyour proceduresfor assessing
tho continuingeducationneedsofthe targetaudience.
tuq,
^
<c-[.o''{P}cloto3[tr
/\ e!-(
F,oJ**
,"J"8,,6 \onrJ
E. Instructiotral StatT
l. Holv do you selgctinstructorsfor your continuingeducationprograms?
\)e q,*tt{'*
o*-- p,-\ ,f ,,.I\ - gt^^bk ,+^'tI
4 pr"{',eer"n,As
2. How do you verifl the competenceofthe instructoE ofyour continuing educationprograms?
l+)< 1,"".{nir
vetorr!, +altccrrlt ,,.uJ .Lr-.-r*q*,
+^A
yu(ftrn-lo"+.
3. Submita PROFILESHEET(Aftachme C) for the presenter(s)
of eachactivity for which you havesubmitteda Program
Form(total of four, unlessan individualpresentedmorethanoneactivitybeing submiiledfor review). If therewas more than
on€ prese[ter for an activity, submit a profile for eachpresenter.
Application - NASP Approved Provider Of Continuing ProfessionalDevelopment
Paset
AttachmeotA
PREVIOUSLY OFFERED PROGRAM FORM
(completeone copy ofthis lorm for each of the three most recently offered programs)
Title of Activity
DateG)_2_:
Numberof ContactHours:
profrle
(atrach
Presente(s)
sheet) Avtr/ R. ,'.|+.cl'r,,,lpr ,Nt sP , tf qd ,
('qs <nndra
C. B/ae,(,lt
s1
TargetAudience
[huryir,4e ,l h,';g 1ko,nf'+,,
^
/a
J
Approx. numberofparticipants___-l
Cevd;ol
.lri,^cl P<).ltJoti<+s
Ll
/.
Approx. numberof participantswho were schoolpsychologistslQl
BriefOutline ofContent(ifnot providedin attachedbrochure):
LeamingObjectives(ifnot providedin artachedbrochure):
| . B< aAe
io c;t<-
2 . Ee alle t
cite
aamy)e<
4
es d
eravnyl
yesro^ln
b^9eJ iv\fervea-rio^S at a,ll thr ee ttert .
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c{a-ra,r^d. c.eir.tif t f'
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skda^r:
5 Un&-vsrr,*.|
sc:,^.4o{l\rc-borvter5t:+,.JLove(its +- -rwy'<neu+\ R+l at the tttjhgi"e,l
LeNel
EvaluationSummary:
fc.r1icip."i^'BXavehShr^'tl^3\ oA 4a Trese-t
al ll.<
+Izir alwltS, 1" <xTlatnr
TvtSoufers,
ln aJJtt'o^,p^r+lui^^tstvyret&J t\ot $z u';orks)n"p
nq+ +)".,,.
l\vte i4arn-ta1oLl'e"":*5.
NorE: ATTACHA coPY oF THEBRoCHURE/ANNoUNCEMENT
usEDTo ADVERTTSE
TIIrs Acrrvrry
Application - NASP Approved Provider Of Continulng ProfessionalDevelopmena
Prge 8
Attachment A
PREVIOUSLY OFFER-EDPROGRAM FORM
(completeone cory of thisform for each of the lhree most recently offered progroms)
Titto of Activity
Date(s)
Number of Contact Hours:
5
(attachProfile Sheet)
Presenter(s)
TargetAudience
)-;
Approx. numberofparticipantswho were schoolpsychologists
Approx. numberof participants
Brief Outl ine of Content (if not provided in attached brochure):
LeamingObjectives(ifnot providedin attachedbrochure):
t. -rwpl^:'
5
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t+e l f
)c*v'
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$r
Evaluation
summaryt
**r'
krr'-,te ,
Je
nl,la.+" renr-l)4.
tr< q uueF+t e\*Li',teJ ;h
laa'uy 'fe"rtzz l-ft
USEDTO ADVERTISETHISACTIVITY
NOTE: ATTACHA COPYOF THE BROCIIURE/ANNOUNCEMENT
Applicrtion - NASP Approved Provlder Of Coltinuing ProfessionalDevelopEetra
Page8
Attrchment A
PREVIOUSLY OFFEREI} PROGRAM FORM
(completeone copy of th'tsform for each ol the three mosl recently ofered prograns)
{" bt+
Title of Activity
) : > )-" ob
Dste(s)
Numberof ContactHours:
Presenter(s)(attachprofilesheet)
Cl'lrroll,Crado"k,
?t^.t>
rarsctAudience
lirn^.uJ e,l-,^,-rrJWol"rqon.I Cnu^-k*,
Approx. numberof participans
-]_
Cevrihlnd &)^ool ?qycl^"loXieB
Approx. numberofparticipantswho were schoolpsychologists
I
BriefOutline ofContent(ifnot providedin attachedbrochure):
LeamingObjectives(ifnot providedin attachedbrochure):
:toysT to i{lt^l assessuOvrt
/ SLrq\lnl
rce- based{rqow lu+ y,o'oie h{alilll , sa+ts{1r
lJ r e n '
EvaluationSummary:
n,.,-"rO,t!'f ro uiv_el hilh(tt rqt-t^Jso^
?re!.rt(tiktr.,rklJa,fafar;loia
.t
veII atfa-a , a-^d caTowie o
1.ag1ipn,.
af ye;e.^-re,C0,1&fr
4.+ ,euhsl^,7 '< L'z.if {^l , a.,,.J+La
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frzie.(ef,
j
a:vsw
of cJl lViv. ttar!n7,,s y .(a<.
+. 4< +" 7c
Covnnen-ts tro^
nDle
t"
NOTE: ATTACH A COPYOF THE BROCHURE/ANNOUNCEMENT
USEDTO ADVERTISETHIS ACTMTY
GJe^'<-
Applicatioo - NASP Approyed Provider OfContinuing ProfesslonslDevelopmeot
Page 9
Attschmeot B
PENDING PROGRAM FORM
(completeone copy of thil form for a plsnned progran)
Tide of Activity
t\
Date(s)
Number of ContactHours:
PresEnter(s)(attachProfi le She€t)
Target Audietrce
L\ceng.A
Anticipatednumberof participants{ O
Brief Oudineof Content(if notprovid€din attachedbrochure):
LeamingObjectives(ifnot providedin attachedbrochure):
t . lrnpwornl4u,,vr6t
elIe*iut sil'ategles
fir
/ . Lva'twtt(
in
gi1znftfe9 w.<*"tf t-
ottl KqJzuf
3 iJz^t:!
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u^dnrr^rz SEL a,nd pocirive,tttfiLr\,4fes, I AteYv()l^flw
po(lrrve,aft'rt,tfej o-f in,hrrJr,{ it*.;^+s
Evaluation Plan:
4e ead o{
Tartciptts will be 1>/e-^a" co.^+lee,trr,rJtrtion
^f
fue u>orksLrop the |^{or'uo61oa oLtatnt |ronn tLre eVal'uta-tion
WTtt l,relp *e to \wtyrovelutuue aror.l.sl,ropr.
NOTE: ATTACH A COPYOF THE BROCHURE/ANNOUNCEMENT
USEDTO ADVERTISETHIS ACTIVITY
(A draftis acc€ptable)
Application - NASP Approved Provider OfConainuing professionalDevelopment
Pace10
Attachment C
PROFILE SHEET OF TRAINER,/FACULTY MEMBER
(completeone copy ofthis formfor theprograms described in AttachmentsA and B)
A. Name
B. Curent Employment
Title
Placeof Employment
C. EducationalBacksround
Highest
craduate
De,r"" Yln.V
,uio,
TJr',t"irt"nl
y
?<yd,,,J,
l eat
tIl \
University
OtherRelatedEducation/Desrees
D. SpecialTraining/Experience
Relevaotto Topic Area(s)presented
{,Lvu,4(uItt,L
Co
'e(oq
E. Certificationsand LicensesHeld
F. OtherPertinentInformation(describeadditionalaspectsofthis individual'sbackgroundas theyrelateio the provisionof
continuingeducationactivities).
NOTE: DUPLICATETHIS FORM AS NEEDED
Application - NASP Approved Provider OfContinultrg ProfesslonalDevelopment
Page10
AttachEenaC
PROFILE SHEET OF TRAINEXYFACULTY MEMBER
(completeone copy of thisform for theprogroms describedin AttachmentsA and B)
A. Name
B. Currcnt EmDlovment
Placeof Employment
C- EducationalBackground
Po/it;ra,(
Highest GraduateDegree
JtVrrp-
University
OtherRelatedEducation/Degrees
SpecialTraining/Exp€rience
Relevantto Topic Area(s)Presented
F. Other Pertinent Infonnation (describeadditional aspecs ofthis individual's background as they relat€ to the proyision of
continuingeducationactivities).
tL/s
fro/artc;at
(ou.uc;/ ,f t4lnois
NOTE: DUPLICATETHIS FORMAS NEEDEI)
SaraA Stolberg,CFPTM,
CDFATM
233N. MichiganAvenue,Suite2500
(312) 616-4687
Telephone
DO.com
Chicago,IL 60601
Fax(312)856-13
19
www. BDO.com
Professional
Experience
Financial PIanner, Tar Advisor.
Div orce F inancial A nalyst
BDO Seidman, Private Client ll/ealth Management
Seidman Private Advisors, LLC
October 2007 - present
Financial Planning, Tax Advice, Divorce Financial Consulting,Divolce Mediqtion
o Provide hnancial planning and inv€stment managementsewices to Chicago-area
clients ofthe 5'largest accountingf,lrm in the world
.
Work with family offices, privately-held businesses,high net worth executives,
401(k) plans
.
Educatestaff and clients on financial plarming matters
o
November
2003 October2007
Can I Keep The House, Inc., Lincolnshire, Illinois
Financial Planning, TaxAdvice, Diyorce Financial Consulting,Divorce Mediation
A settlernenttoolfor aftorneysand mediators
o Provide comprehensive frnancial planning, including college planning, estate
planning, investment review and allocation, retiement planaing, tax planning,
post-divorce frnancial planaing, pre-nuptial consulting, ftansitions consulting, life
insurancepolicy review, 3'dparty purchaseof umeeded insurancepolicies
.
Provide pre- and during-divorceconsultingincluding budgeting,liugauon suppon
o
Provide divorce and family mediation servicesincluding post-decreemediation
.
Help attomeyssettlecasesby: creatingsettlementscenariosacceptableto both sides,
helping clients prove their needs/abilityto pay
.
Use licensed and prop etary software to determine long-term effects of settlement
proposals,balancechild support vs. alimony scenanos
.
Calculateand testify to tax implications, stock option and pension valuations
.
Teach attomeysto use FinPlan, other divorce financial softwarepackages
o
Draft documentsfor aftomeyssuch as QDROs, QILDROs, discovery lists, lifestyle
analysis,financial affidavits, graphsfor court presentations
Provide tax services: Federal and state 1040 preparation, Federal 1041 trust
retums; tax advice and consultingyear-round
e
o
o
Financial Planner, Tax
Advisor, Divorce Financial
Planner
November
2002- November
2003
Financial Planner, Tax
A dvis or, D ivo rce Fin ancial
Planner
February1990- November
2002
Expand divorce planning practice frorn previous company, Can I Keep The House,
Inc.
Presentseminarsfor the public as well as for attomeys,Realtors,CFps, CFpAs
Satelliteoffices in suburbanChicagoby appt
Divorce Planning & ConsultingLLC, Deerfield, Illinois
A subsidiaryof FrostRuttenberg
& Rothblott(F R &R)
.
SeeaboYe
Money Matters, Arlington Heights, Illinois
Self-Employed- Financial ServicesCompany
.
Tax preparation
andadvice
. Comprehensive
financialplannirg
e DivorceplanningsinceJanuary2,2002
and other locations
Education
Divorce Mediator training
June2005
Associationfor Conflict Resolutionand Northwestern 1Jniversity
Requiredtrainingto becomecertifiedasa divorceandfamily mediator
CollahorativeDivorcetaining
CollaborativeFamily Law Council of Wisconsin
May 2003
Requiredtraining to becometeam membir in CollaborativeDivorce semns
CertiftedDivorcePlanner
July2001- March2002
Institute of CertiJiedDivorce planners
planning
Certificate
in DivorceFinancial
CertifiedFinancialPlanner
February1989
1990
- December
RooseveltUniversity,Chieago
planning
Certificate
in Financial
Bachelor of Arts Degree
Binghamton lJniversity,Binghamton,New york
Major in Political Science,graduatedwith Honors
Licenses
.
NASD Series
7,63
r
Insurance
- Life, Health,Accident,Disability,Long-TermCare,VariableAnnuities
RealEstateContinuingEducationInstructor,Agent
.
SpeakingEngagements
.
"Helping Clients Take Conffol ofTheir Divorce,', The Chicago School of
ProfessionalPsychology,F ebruary23, 2008, Chicago
o
"Every Woman's Guide to Divorce',, The Women's Initiative of ItascaBanl,
September25, 2007, Schaumburg
.
"The Team Approach to the PracticeofCollaborative Law,', panel member,April
4, 2007, LoyoLaUniversity Law School,Chicago
.
"Ask Questionsofa Panel ofExperts", November 6,2005, Divorce University,
semi-annualworkshop on divorce for women, Evanston
r
"The Financial IssuesofDivorce", September22,2005, Financial Forum ofthe
Financial PlaruringAssociation oflllinois and the Illinois CpA Society, Rosemont
r
"Critical Financial Errors in Divorce", November 19, 2003, Cook County Bar
Association
.
PastPresident,Divorcelllinois.org - StateAssoc. ofDivorce Financial professionals
President,Allied ProfessionalsCouncil of GreaterChicago
ProfessionalActivities
o
o
r
Chair, North Shore Collaborative Law practice Group
Member, Mediation Council of Illinois
CommunityActivities
o
.
Commissioner,Buffalo Grove Village Zoning Board of Appeals
PastPresident,local religious organization
.
ParentRepresentative,Twin GrovesMiddle School Iruovement Team
ii;"tT;n""
- nnt" ApprovedProviderof continuingprofessionat
Development
AttachmentC
PROFILESHEETOF TRAINER/FACULTY
MEMBER
,
(complete
one copy of thisforn
for theptograhs describedin Atta"n."rJ
.ro ul
B. Culrent Employment
Title
PlaceofEmployment
EducationalBackground
HighestGraduateDegree
v.A
Major
Yea-2DDB
University
OtherRelatedEducationDegrees
SpecialTraining/Experience
Relevantto .fopic Area(s)presented
3- f)erei
nq4
e/
luyoii
+o ,,,,22.r i/a
ueJc
ef llacleatS
Certifications
gela llli
andLicenses
t
:ffiitrJHil:f#:|?i}!t;'-to"
aspects
orthisindividual's
background
astheyrelate
totheprovision
"oont"nal
or
NOTE: DUPLICATETHIS FoRM As
NEEDED
l32l W Lawrence
Ave,#1
CASSANDRAC. BLACK
Chicago,
IL 60640
12) 848-0432
Knowledgeof andexperience
with usinga problem-solving
model,Response
to Intervention
(RtI),research-based
methodsandinterventions,
anddata-based
decisionmakingusinga 3{iered
model of supportto meet the needsof students
Effectiveleadership
andcollaboration
skills demonstrated
by facilitatingmeetingsand
committees
with successful
outcomes
Professional
work experience
with diversepopulationsandagegroups
Teamworkandleadership
skillsdemonstrated
by successful
coachingexperience
with athletes
rangingin agefrom 8 to 18.
Illinois StateBoardofEducationType73 certificate:SchoolpsychologyEndorsement
NationallyCertifiedSchoolPsychologist
EDUCATION
Mastersof Arts: Educational
Leadershio
Roosevelt
University.
Schaumburg,
IL
Educational
Specialist:SchoolPsychology
Universityof NorthemColorado,Greeley,CO
Bachelorof Arts: Psychology(CumLaude)
AugustanaCollege,Rock Island,IL
GPA:4.0/4.0
August,2008(Projected)
GPA:3.9/4.0
August,2002
GPA:3.6314.0
May, 1999
SchoolPsychologist
08/04-Present
NorthemSuburbanSpecialEducationDistrict
I .akeForestCommunityHigh SchoolDistrict I 15,LakeForest,IL
F Guestpresenter
at multipleworkshopsandconferences
regardingthe useof problem-solvingand
RtI at thehigh schoollevel
F Coordinatorof specialeducationservicesto studentsattendingprivateiparochial
schoolswithin
our district'sboundaries
Act asthe LEA representative
at IEP andSection504meetings
Facilitatea committeeaddressing
areasofstudentneedandtargeted-goupinterventions
and
resources
within thebuilding
Supewiseschoolpsychologyintem andpracticumstudents
Memberof COREteam(BuildingProblem-Solving
Team)
Provideprofessional
development
opportunities
for staffmemberson a varietvoftooics
Section504CaseManager
Memberof the SocialAcademicLeamingprogramteam:provideindividualandgroup
counseling,
teacherconsultation,
andparentgoups for studentswith emotionalandbehavroral
diffrcutties
{._f.
)
\a
Application - NASP Approved provider of continuing professional
Development
Page10
Attachment C
PROFILE SHEETOF TRAINERYFACULTYMEMBER
A. Nur.
(completeone copy olthis form lol theprograms describedin
AttachmentsA ond B)
, I
'*
-i
rt
B. CuFent Emplo)'ment
/1
r
,
r]
ritre S< Loo[ ?<v\oloq',s{
Placeof EEployment
C. EducstionalBackground
Highest
claduareDegr""
H-A .
yulo.
Unive6ity
Other RelatedEducation/Degrees
D. SpecialTraining/ExperienceRelevantto Topic Areds) presented
sckoL I
ertil
E. CeltificationsandLicensesHeld
F other PertinentInformation(describeadditionalaspectsofthis individual's
backgroundasthey relatsto theprovisionof
continuingeducationactivities).
NOTE: DUPLICATETHIS FoRM As NEEDED
Amy B. Altschuler, NCSP, LCSW
569Whittier Avenue
Deerfield,IL 60015
(847) 404-0370
AmyBethT2@comcast.net
oBJEsrrvE
To obtain employmentin a schoolasan administrator/psychologist.
EDUCATION
RoovueltU ueri!, Schaanberg
IL
Mastersin EducationalLe'adership,
expectedgraduationJuly 2008
N atiotal-Lorit Utiwnifl, EaauloL IL
Ed.S in SchoolPsychology,
June2003
Adler SchooloJPrtfeaioralPycholog4Chicago,
IL
37 semesterhours towardPsy.D.
lantary 2000- Match 2001
UnaeniE af Chrcago,
SchoolofSocialSeruiuAdninistration, Chicago,
IL
M.A. ClinicalSocialWot( June 1996
Honors: Brink Fellowshipfor FamdySuppott Specializa
ion,1994,1996
Miani Uduedg DoliboirEaropeatCertar,Gred Duchl of Laxenboury
Honors:JosephM. deNardiEuropeanCenterScholarship,August- December1993
Miani United!, Oxford,OH
B.A., Cum Laude,1993 Major: Fhstory
Honors: Dean'sList four semesters
out of seyen
OutstandingAcademicAchievement,1990-1991
Alpha LambdaDelta, NationalHonors Society,7990-7991
Phi Eta Sigma,FreshmanHonon Society,1990-1991
FIELD EXPERIENCE
SCHOOL PSYCHOLOGIST
SchlolDttiLt 115,I-ake Flft Higb Scbool;
Lake Fotwt, IL
Aagust2004 - Pruent
o Play an active role in developing the problem solving processwithin the school
. Attend monthly meetingsregardrngTier II problem solvingintewentions
o Attend weeldy student referral team meetings
.
Generateintefventionsfot referredstudentsand monitof progress
. Attendedmonthly '?roblem SolvingAcademy"meetingswit]r Matk Shinn
r SuPerviseschoolpsychologyintetns and schoolsocialworker
o Administerindividualdiagnosticassessmerlts
of studentlearningneeds
o Conductindividualand group counselingw.ithstudents
o Consultwith teachelsto gatherinfotmation tegardingsrudents
.
ComDletestudentdassroomobservations
.
Casemanagerfor 504 str-rdents
o Attend/Lead IEP and 504 meetines
<"{.>
Application - NASP Approved Provider OfContinuing pmfessionalDevelopment
Psge 10
Attschmelt C
PROFILE SHEET OF TRAINER/FACULTY MEMBER
,c,.Name
(completeonecopyof lhitformJor theprogramsdercdbedin Alachments
A andB)
/^\
/
tr
LA.troll
Lr^ohoz.L- .. Ph f)
B. Current Employment
m" Pwec+or o{ EaL*vicr*l lte+ldt ,leylte s
Placeof Employment
C. EducationalBackground
Highest
craduateDegr""
?h . V
u^io,
Year ( q17
Unive.sity
OtherRelatedEducatioD/Degrees
D. SpecialTraining/Experience
Relevantto Topic Area(s)presented
E. Certificationsand LicensesHeld
F. OtherPertinentInformation(doscribeadditionalaspectsofthis individual'sbackgroundasthey relateto the provisionof
continuingeducationactivities).
NOTE; DUPLICATETHIS FORM AS NEEDED
Curriculum Vitae
Carroll Ann CradockoPh. D.
411 SouthSangamon
Suite2A
Illinois
Chicago,
60607
Work: (372)243-7441
Cell:(312)39r-7524
cacradock@aol.com
EDUCATION
1977
Illinois
Ph.D.,ClinicalPsychology,
DePaulUniversity,
Chicago,
psychological
Dissertation:
Behavioral
Prophylaxis:
A testof Poser's
publicspeaking
immunization
hypothesis
onsubjects
displaying
sub-clinical
anxlety
1976
M.A., ClinicalPsychology,
De PaulUniversity,Chicago,Illinois
Thesis:Impressionmanagement
in schizophrenia
LICENSE
1977- present
g1st,# 07l-002231
LicensedClinicalPsycholo
Stateof Illinois
PROFESSIONAL E)PERIENCE
2001- present
DirectorofBehavioralHealthServices
ou:"T#l"J.'#il:"T.Y;jfil
:"ilH;:lfi?:;'*,",,"nt
and
ambu,a,ory
o
1979- present
2000-2001
servrces
includingCommunityBehavioralHealthCenterandBehavioral
HealthServicesat primaryandspecialtymedicalclinics.
Management
of budgetof $16,000,000;
and35
80 full-time employees,
psychiatry,socialwork, addictions,and
traineesin psychology,
counseling,
includingan APA-approved
clinical psychologyintemship.
Leadresponsibilityfor accreditation
for
andregulatorycompliance
behavioralhealthservices:
JointCommission,Illinois Department
of
PublicHealth,Centersfor MedicaidandMedicareServices,
Illinors
Departmentof MentalHealthMedicaidRehabilitationOption@ule
132).
PrivatePractice
Chicago,IL
o Clinicalpractice:Children,adolescents,
adults
. Consultation
to business,
healthcareandsocialserviceorganizations,
schooldistricts,andreligiousdenominations.
Directorof AmbulatoryBehavioralHealth
AdvocateRavenswood
HospitalCommunityMentalHealthCenter,Chicago,IL
Application - NASP Approved Provider Of Continuing profecsionatDevelopmetrt
Page5
F. Evaluatiol
l. Describethe method by which evaluationsare obtainedfrom participants.
cl:ut'o,t.n.- ct+ 4e <t^'J
Xite.w'tb-ta-,a {ezAba*'-al;;r,q,+ -4'z rr or*shoP; -- ---
A coo-vse evaluatr!*
.;tl
be
2. Explain how your organization utilizes theseevaluationsfor future planning.
th"
tetAL^"F
{vo^
'Il'a eur*l^ariu,,4s !4.Tlt helT ue qtalna-te
4ne
J h.lp
+ ll€ cc'\vte- r la*icllan+3! yedd+ov9f- +,a ro*vse, ,r,n,
rgJeeS"t <l,o co".< #
.
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C,Jqler^t
.rs
3. Submit a sampleevaluationform and a summaryofthe evaluationsthat have be€n completedby participants for the three
previously offered programsfor which you completedAttschmeot A forms. You may use thrce-blankivaluation forms
oq
which you may write the total numbers.
G. Awarding Contsct Hours
l. How do you veri$ an individual'sparticipationandcompletionof an activity?
F1
Yu (r t''lparts \/,r)r^J (e ff.Llye +a
4lrerr- €wrve FiioJ
att,*^*
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p^Yn'(ilvrr,tts*r,rtshr\
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ve+il-y-+Ieiv. tt"ly'en'"rnf
{}.e cuor{<.hop-
2. Indicate the type ofdocumenlation that you give to the participantsupon completion ofan activity, and the informatioD lhat this
documentation
contains(you may enclosea sample).
Snwrpk Lncio,
./ Doo,tt-n^-|;afi"^
r.,f A+-te-uJa.uc-e--
3. Do.you maintain rostersofparticipants and evidenceof thc evaluation for a pedod offour years following the date of rhe
activity?
Yes ]1
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No _
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trt.-
ContinuingEducationWorkshopEvaluation
Saturday,February23
9:00am- 12:00pm
--
HelpingGlients Navigatethe TreacherousWaters of Divorce to a Safe port
--Presented-byearnllCafrfozk;pnD
Presenter's
knowledge/expertrse
lowest 1 2
Preparation
of presenter
Concepts
wellexplained
Responsive
to questions
3 4
12
5 highest
3 4 5
tz.tzfc
1234
5
Met leamingobjectives:
Uponcompletionof this workshop,participants
will be able to:
e Definehealthy,satisfyingpos! divorcelife.
1 2
3 4
5
o Explainevidence-basedfactorsof healthv
posfdivorcelife
1 2
3 4
s
o Definethe role and expertiseof life coaches,
parentingcoordinators,
childrepresentatives,
mediators,and attorneys.
1 2 3 4
s
o ldentifyand integratetwo evidencebasedfactors
1 2 3 4
s
Additional
Comments:
ContinuingEducationWorkshopEvaluation
Saturday,March8 2008
1 :3 0 p m
- 4:30pm
Responseto Intervention:ProblemSolvingat the High SchoolLevel
PresertledCassieBlack,NSCP& ArrtyAllscltuler,NSCF,ISCW
Presenter's
knowledge/expertise
lo we s t 1 2 3 4 @ n ig n " . t
Preparation
of presenter
1234
t5)
Concepts
wellexplained
1234
{s)
Responsive
to questions
1234
{51
Metlearningobjectives:
Uponcompletion
of thisworkshop,
participants
willbe ableto:
.
Citeexamplesof research-based
interventions
at all threetiers.
12 t oo
.
Citeexamplesof methodsof gathering
dataandusingit to supportstudenrc
1 2 3 4a
.
Discusssomeof the benefitsandbarriers
to implementing
R at the highschoollevel
r\
1 2 3 4 ( 5)
Additional
Comments:
,<t zz-;b'h'a^
v( t-'z-'t'-'Z/
t/-2*/,
/t--a'-'t''< :/o<-2"'?\
Gontinuing Education Workshop Evaluation
Saturday,February23
1:30pm
- 4:30pm
HelpingClientsTakeGontrolof Their Divorce
Presentedby SaraStolberg,C.F.P.
Presenter's
knowledge/expertise
lowesl tr1 E2 tr3 D4
E5 highest
Preparation
of presenter
!1
D2 tr3 a 4
x5
Concepts
wellexplained
tr1 a2 !3 D4
a5
Responsive
to questions
tr1 a2 n3 D4
E5
Metlearningobjectives:
participanls
Uponcompletion
of thisworkshop,
willbe ableto:
.
Explainthe basicprocessof divorceto yourclients.
!1
.
Helpyourclientpreparefor divorcelegally.
tr1 E2 !3 tr4 E5
.
Helpyourclientpreparefor divorcefinancially.
tr1 a2 !3
tr2 tr3 tr4 trs
tr5
-4
Additional
Comments:
presented.
Thiswasan eyeopenerin termsof the information
lt mademe realizedhow
comDlex
matterscanbe whenit comesto divorceandthefinancialissues.As I saidfor the
morning
workshop,
for the population
I workwithin the ChicagoPublicSchools,it wouldbe
interesting
to takea lookat whataretheissues,circumstances
whenthereis divorce,
separation
or abandonment
andwhatcanthe mothersdo to improvethe chancesof getting
financial
supportundertheircircumstances.
ThefamiliesI workwithdo nothavetoo many
assetsto dividebut haveothertypeof issuesthatwouldbe important
to learnaboutto helpthe
children
in theschoolsandorientthefamiliesaccordingly.
GontinuingEducationWorkshopEvaluation
Saturday,February23
9:00am
- 12:00pm
HelpingClientsNavigatethe TreacherousWatersof Divorceto a SafePort
Presentedby CarrollCraddock,Ph.D
Presenter's
knowledge/expertise
lowest fl1
A2
tr3 D 4 85 highest
Preparation
of presenter
tr 1 a 2 n 3 !4
Concepts
wellexplained
n1 E2 tr3 tr4 a5
Responsive
to questions
tr1 a2 !3 D4 trs
x5
Met learningobjectives'.
Uponcomplelion
participants
of thisworkshop,
willbe ableto:
.
Integrate
keyfactorsintoinitialassessmenVscreening
basedon an understanding
of
recentevidence-based
factorsthatpromotehealthy,satisfyingpost-divorce
lifefor men,
womenandchildren
tr1 E2 !3
.
X5
ldentifyappropriate
usesof divorceprofessionals
basedon an understanding
of how
divorceprofessionais
canassistin promoting
healthyposfdivorcelife:coaches,
parenting
coordinators,
childrepresentatives,
evaluators,
mediators,
attorneys.
tr1 32
.
tr4
tr3 n4
E5
Integrateevidencebasedfactorsthat promotehealthydivorceadjustmentinto
counseling
or mediation
interventions
!1
E2 !3
tr4
tr5
Additional
Comments:
I foundthe seminarvery helpfulfor my privatepracticeto dealwith clientswho haveto face
problems
of divorce.
Application - NASP Approved Provider OfContinuirg ProfessionalD€velopment
Page6
H, RcsponsibilityandRespotrslveness
l. How will you be responsiblefor ensuring that the continuing educationactivities offered by your organizationfor NASP
approvedhours adhereto the NASP Pnncipleslor ProfessionalE rirr? (downloadableat v/wl .nasponline.org)
E{ERY coNnNurNlq EtrJrlrroN Acrrvrly 19 REVt(:i^JEp Two s}iavt-By
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policy.
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Cmcellationhefundpoliry
Number of contacthours
-y(
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Fee
Credentialsof instructor(s)
( Cea c,ihckwreqat.
If you are not cu.rently including all of the above items, do you agreeto do so once you are grantedNASP approval?
l/
Yes Ll
No -
5. Describetheprovisionsthat are madeto ensuretheprivacyofany confidentialmaterialthatmay be presented.
WE rv,uu
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GrievanceProcedure
Education
ContlnulngProfessional
The chicago Schoolof ProfessionalPsychology
March5, 2008
in
to conducting
allactivities
TheChicago
Psychology
is fullycommitted
Schoolof Professional
EthicalPrinciples
of
Psychological
Association's
strictconformance
withtheAmerican
to be
Psychologists.
TheChicagoSchoolwillcomplywithalllegalandethicalresponsibilities
program
of program
non-discriminatory
in promotional
activities,
content,
andin thetreatment
participants.
willbe the
of compliance
withthesestandards
Themonitoring
andassessment
with
(EPE)in consultation
Education
andProfessional
responsibility
of theDirectorof Executive
theVicePresident
of Academic
Affairs.
and
for all participants
WhileTheChicago
Schoolgoesto greatlengthsto assurefairtreatment
problems,
of the
issueswhichcometo theattention
to anticipate
therewillbe occasional
attempts
and/oractionon thepartof
Executive
Education
staffwhichrequireintervention
andProfessional
description
servesas a
theEPEstaffor an officerof TheChicagoSchool.Thisprocedural
guideline
grievances.
for handling
such
Whena participant,
andexpectsactionon the
eitherorallyor in writtenformat,filesa grievance
complaint,
thefollowing
actionswillbe taken.
or thestyleof
1. lf thegrievance
concerns
a speaker,
thecontentpresented
by thespeaker,
presentation,
the individual
filingthegrievance
willbe askedto putheror hiscomments
to thespeaker,
in writtenformat.TheDirector
of EPEwillthenpasson thecomments
theconfidentiality
assuring
of thegrievedindividual.
or the
2. lf thegrievance
concerns
a workshop
offering,
itscontent,levelof presentation,
facilitiesin whichthe workshoD
wasoffered.the Directorof EPEwill mediateand be the
finalarbitrator.lf the participant
requests
action,theDirectorof EPEwill:
or
a. Attemptto movethe participant
to anotherworkshop,
b. Providea creditfor a subsequent
workshop,
or
c. Providea partialor full refundof the workshopfee
Actions2b and2c willrequirea writtennotedocumenting
thegrievance
for
recordkeepingpurposes.Thenoteneednotbe signedby thegrievedindividual.
TheChicagoSchool's
3. lf thegrievance
concerns
CE program,in specificregard,the
Director
of EPEwillattemotto arbitrate.
Appucation - NASP Approved Provider OfCotrtinuing ProfessionalDevelopment
Page7
l.
Co-Sponsorship
l.
Hasyour organizrtionin thepas! or doesit prcsently,co-sponsorcontinuingeducationactivities?
Yes
2,
No X
Completethe following cableand attach a brochure/announcement
for eachactivity that your organizationco-sponsoredwith
anotherorganizationduringthe pastyear. lncludea copy of your writtenco-sponsorship
agreementgovemingthe planningof
eachactivity:
Activitv/Prosram Title
3.
Co-SponsoringOrganizstiotl(s)
Doesyour organizationplanto co-sponsorcontinuingeducationactiyitiesin fte future?
Yes4.
D8te(s)ofActivity
wo X
Ifyes, attacha copy ofthe written co-sponsorship
agreementthatyou will use.Doesyour organizationagreeto abideby the
provisions of co-sponsorshipspecified in the NASP ,{pproved Provider of Continuing Education Policies and Guidelines?
Yes -
No
5. Describeor attachthepoliry thatyour organizationfollows for themanagement
ofco-sponsoredactivities.Speciryhow your
organizationmahtainsresponsibilityfor meetingNASP providerrequirements.
SOOZEutrdg
pf EulnulluoC
0T909
lll 'obecrq3
qiloNszt
sllaM
leerls
pueuoqeJnpfalelodlof
sef,rruas
6ur1;nsuo3
icagoScho
TheCh
Psychology
of Professional
Twelve New
Workshops
Register
Now and
Earn GEUts
February 23r 2OO89 a.m.
March 8,2OOB9 a.m.
Helping Clients Navigatethe Treacherous Cultural ResponsiveTherapy: Working
Waters of Divorce to a Safe Port
with Latino/Latinas
.
Presented by Catoll Craddoc& Ph.D.
Counseling
andmediation
duringa divorcehave
betterresultswhenthey are providedby
professionals
whoaligntheirworkwith research
on
factorsknownto promotea goodpost-divorce
life.
Whilesomeof thosefactorsare common,othersare
differentfor menandwomen,"leavers"andthose
left,olderandyoungerpeople,childrenandparents.
Incomelevel,education,
religionandculturealso
matterin termsof whatactuallyhelpspeopleadjust
to post-divorce
life. ThisworKhop will present
recentresearchfindingson thesefactorsand
illustrate
howtheycanbe integrated
intocounseling
withdivorcing
and mediation
familiesto improve
outcomes.The rolesof other divorceprofessionals
parenting
suchas coaches,
coordinators,
child
representatives
and collaboration
among
professionals
will be addressed.
February 23 2OOA{:3O p.m.
Helping ClientsTake Control of Their
Divorce
Presented by Hector Torres, Psy.D.
Thiscourseprovidesan overviewof Latino/as'
culturalbackground
anddiscusses
howcultural
factorsinteractwith mentalhealth.Particioants
will
be engagedin discussions
on topicsrelatedto
gender,family,class,
cultureand identity,including
race,age,tradition,values,religion,
sexuality,
acculturation
andassimilation,
and howtheseare
relevantto psychotherapy.
Participants
will be able
to betterunderstandthe role of culture,family
structurefethnicity,gender,socialclass,and
in symptomformationandthe
acculturation
experience
of psychological
disorders.
Finally,
participants
practice
will be introducedto the
of
culturallyresponsive
assessments
and interventions
that havedemonstrated
to be effectivein work with
populations.
Latino/a
March 8,2OO8 1:3Op.m.
Responseto Intervention: Problem
Solvingatthe High Schoollevel
Presented by Breeda McGrath, Ph.D.
Implementation
of responseto intervention
approaches
to instructionare largelyfocusedon the
elementary
level.Thisworkshop
will address
strategiesfor introducingRTIto highschoolteams
andwill provideexamples
of research-based
interventions
at all levels(Tiers1, 2, and3) that are
specificto the needsof high schoolstudents.
Presented by Sara Stolberg, C. F. P.
you are oftenthe first to comein
As counselors,
contactwith familiesfacingthe decisionsof divorce.
Youshouldbecomeeducated
aboutthe legaland
financialramifications
of thisdecision.Manylongterm effectsof divorcecan be mitigatedif smad
choices
are madeat the righttime. Yourclients
trustyouto guidethemthroughthe divorce
process,so your adviceis a valuableserviceto
yourinput,and
them. Yourclientswillappreciate
you will differentiateyourselffrom other mental
healthprofessionals
becauseof your expertisein the
field.
TheCh
icagoScho
of Professional
Psychology
Gost for Each 3 Hour Session (3 GEU's)
GeneralPublic
$85 oer session
$150for two sessions(includeslunchwhenboth are on the sameday)
Gancellation and Refund Policy
The Chicago School Community
ChicagoSchoolinternship/practicum
sitesupervisorsand communitypartneE$75
for one sesson,$130for two with lunchwhenoffered
Alumni$65for onesession,
$120for two withlunchwhenoffered
StudenEand ChicagoSchoolAdjund Facdty$45 for one session,975for two
wth lunchwhenoffered
Chicago
khool Program
andAffiliateFaculty
attendat no cost. Youmustbe
registered
to aftend.
Groupratesavailable.Please
inquireat Consultano@thechicaooschool.edu.
Cancellations
up to oneweekbeforethe workshopwill be refunded100%.
Cancellat|ons
fewerthan five businessdaysbeforethe workshopwill be refunde'd
75i%. Youmayalsochoos€to applyyour paymentto a firtures€ssioninsteadof
re€eivinga refund. We'resorry but no refundswill be givenff we do not receive
a cancellationrequestfrom you, We reseruethe right to cancelany s€ssionfor
whichenrollmentis insufficient.Registeredparbcipantswill re€eivea 100o/o
aefundin the eventlhat we cancelasession,
March {5,2OO8 {:3O p.m.
Modelsof ClinicalSupervision
Presented by Marla Vannucci, Ph.D.
Thisworkshopprovidesparticipantswith a better
understanding
andapplication
of the principles
and
involved
with clinicalsuoervision.
Models
Dractices
andapproaches
to supervision
will be reviewed
alongwiththeirunderlying
theoretical
framework.
Aprll12,2OO8 9 a.m.
ExpandingExecutiveAssessmentsto
include Law Enforcement
C;ootdinated by Steven Griffrn, Ph.D
Thispresentation
will expandon the audience's
knowledge
andexperience
with executive
assessments.
We will go oversomeassessment
featuresin personality
andcognitive
testingto enrich
yourpractice.Thereis a focuson expanding
executiveassessments
to includelawenforcement
executives-thedecisionmakers-asimoortant
decisionsin law enforcementoftenentailthe public's
safetyandwell-being.
March 29,2OO8 9 a.m.
PsychologicalSuitabilityAssessmentsfor
High Risk Occupations:Focuson Law
Enforcement
Ptesented by Steven GriflTn, Ph.D
Presentation
will reviewmultilevelratingstypically
usedin psychological
suitabilityassessments
in law
enforcement
applicants.A varietyof testingissues
psychometric
propeties,and test scaleswill be
coveredto givethe audience
members
bothan
appreciation
for, but moreimpoftantly
a working
knowledge
of howto screenin andscreenout
for jobs requiring
applicants
integrity,selfconfidence,
andassertiveness
skills.
March 29r 2OO89 a.m.
BehavioralTreatmentsfor Childrenwith
April12,2OO8 {:30 p.m.
PositivePsychologyin the Schools
Presented by Ellis C;opelan4 Ph.D.
Thisworkshopwill providean introduction
to the
tenetsof positivepsychology
and its usefulness
in
schools,
bothfor studentsandadults.
April {9,2OO8 9 a.m.
A RisingFemaleJuvenileJustice
Population: Assessmentand Gender
ResponsiveTreatment
Autism
Presented by Denise Ross, Ph.D.
Professionals
treatingchildrenwith autismmay be
challenged
by theirclients'varyinglanguage
and
behavioral
development.
To addressthis issue,
participants
in thisworkshop
will be introduced
to
severalinterventions
designedto successfully
addresstheirstudents'behavioral
andlanguage
characteristics.
the workshop
Specifically,
will begin
witha briefdescription
of appliedbehavior
analysis
andautismbeforedescribing
severalresearch-based
interventions
that havebeenusedby parentsand
educators
of childrenwithautism.Participants
who
complete
thisworkshop
will leavewith an
introductionto basicbehavioraltoolsand strategies
that can assistthem in the treatmentof children
withautism.
March 29,2OOg {:3O p.m.
Ethics and Professionallssuesfor School
Psychologists
. '
;h
Presented by tames Walsh, Ph.D.
Usingcaseexamples,
thisworkshop
will consider
a
presented
varietyof ethicalditemmas
andchallenges
to schoolpsychologists
in publicschoolsettings.
Instructional
strategies
includelecture,guided
discussion,
and interactivepractice.
Presented by Titrany Mastun, Psy.D,
Thisworkshopprovidesan overviewof the issues
facingfemalesinvolvedin thejuvenilejustice'
system.Paticipants
will becomefamiliarwith
specificmentalhealthproblems
commonamongthe
population.The prevalence
femaledelinquent
and
impactof traumaon delinquency
will alsobe
explored.As a result,pafticipants
will learnto
effectivelyidentifyfactorsthat contributeto female
offendingand be introducedto genderresponsive
treatmentmodelsto allowmoreeffective
intervention.
TheCh
icagoScho
of Professional
Psychology
Registration
rrfessional
icagoSch
Psychology
yourspacein ourSpringContinuing
Clipandmailthisregistration
formwithyourpayment
nowto reserve
Education
Workshops.
Youmayalsoregister
onlineat TheChicagoSchool.edu,
whereyouwillfindfacultybios
presenters
you
look
of our
aswell. We
forwardto seeing !
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($85per session)
!
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Partner($75per session)
fl Chicago
Alumni
School
($65persession)
n ChicagoSchoolStudentor Adjunct
($45per session)
!
ChicagoSchoolProgramor Affiliate
(nocharqe)
FaculW
SaturdayAfternoonSessions1:30-4:30 p.m.
SaturdayMorningSessions9 a.m.- Noon
February23
February23
E Helping
Navigate
Clients
theTreacherous
Watersof Divorce
to
' a SafeHarbor
March I
E Helping
TakeControl
Clients
ofTheirDivorce
tr aj*r1 Responsive
Therapy:Working
withLatino/Latinas
March 8
E RTI: Problem
Solving
attheHighSchool
Level
March 15
E Models
of Clinical
Supervision
March 29
March 29
E Psychological
Suitability
Assessments
for HighRisk
Occupations:
Focus
on LawEnforcement
n EthicsandProfessional
issues
for SchoolPsychologists
E Behavioral
Treatments
for Children
WithAutism
April 12
April 12
E Expanding
Executive
Assessments
to IncludeLawEnforcement !
April 19
E A Rising
Female
Juvenile
Population:
Justice
Assessment
and
Gender
Responsive
Treatment
Totalsessions:
Mail with payment to:
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and Consulting
Services
TheChicagoSchoolof Professional
Psychology
325NorthWells,Chicago,
IL 60610
Yourregistration
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Consultino@thechicaooschool.edu.
Totaldue: $ _
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Positive
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