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. c4\ cA@ -tttl V9\Lv\ovoqY gcptooL &^r o (e $6g attaJ^,,t<^'r (tr Si-FtV€s R:LL| tLt fo 6€ T4€ 6.j-toe!- ctF l T5 fylr99r or{ fFtRo{rlifi atlotcE rN lzQoFE!9toNA L_ tNr.rglATt oN 4 a{,rAU T\f. sa'l itifar,t,tion "12 2. Bdefly statethe specificgoalsofyour continuingeducationprogramfor schoolpsychologists, indicatinghow theserelateto the overallgoalsof your organization. TH€ kaAL 0F o\rR. CoNrrN\r"rjk -E-pUa\n or.l PRoqR L|CG^J1,EI" S<HooL 4 t5 ae ?RovtDE vi'l Lt\owq\+7t, o"R ALuhlldl FNO coulAq ,N T$erR Af,eA cF -atP-ee{r3E See d-tail attac[,tag,r1 &r vEs T? e{prN> -rHEIR krijct^./LEvt{e * *tLLs L+,^:l tu{or*t+ior' 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 c.E. SpoN!vR / 9-rk1:i aF tLLtNols pf4tfre<6D 5. sacIAL-NcRtsERcE e|o,'reoRLlcErurir6E AT THt aw(E oF rLLlNurs TH*Ary CE epo^jtoRLrr!Nlu)RE. Ai _7.:FtL T-AHTLY . I,tARAtAEt.r\l\tD .eAye,.oF iril^rc/< 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 o"V/ bz Azld f^ oa/. (ia.Lt1to4,!L C/,;rX, ^rf,o t'[ aiJ4 ,<ol^ aa orer-AzaLJ r Iicnlzclor ,t-s auJ oien, 2. what accommodationshave been madefor program participants who have physical disabilities or sensoryimpairments? 1b At"aXoS,+nt a^ftes t)4" ar^J,rytnws yeyr,l^>j rL,_ arunt( J4^A"A "!t lou-,s ba(E<xs ae To+et*z-dt,/-p"rfitp^.u ,"'t]v. dnrD/.ihy it ^ eA"d,.J €o.^" pa"t'a1rtU't irr uttLy , rc1^tlt ressona-Lle acuo n "-'6 T:o ,rd-?.I'rffM5 .tr-f* rt^ +a_ ,aag. 1y<<tfr c ( o "\-rse n tplo ve4</ r<re,c.*s 6,/2 xalt a,,t "tl*v-noJdr^\,u,s iuJ^,-^5 \h4 s <l^.cal (e sa+-veA -tLe- r<!it-t -t3 selt* 4.e it y^u,_dza, a9 1e.,+iz_ ?_4 ,u* *_r: if lz2,''\t +tn iu .{'{r..,;*4r i"^5 ^ dr's_w.Jp_;t a*J Jo w* lt,.d_u^z^+a,2 .^l1a, -.rt * ?tt,'^-' or ata-J<.u^i s<a,a'Js/"Ls. s*rJ^- aiJS ^, J s4!1.,1:LL4*<. 9i.e.tav*Tt^aa! "J, a ;:;,;X::,.6"cit t\ ,o"<u{tr.n\n -'{+.- pa.r>y.uvttsu)aJihg rJ""t;Iu,t +* *Js 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 . *.{oJ.+Xo{.ter,-^5 c{a-ra,r^d. c.eir.tif t f' sfPo# 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 4q- baa\ L t+e l f )c*v' rlely 7e"7 frL,(et; of Jtvo"cz fo .\De{ dle+r5 Clie,a+ yel.,rye {,r Jiuo.,-. tegatly 6lle,* Aiur.r< {n^o.">ull4 fr. ?*. $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 7""">r7^n-rt fis5sa! 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:! Soor^!frol'o"al Letrnr*16EL) 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 $16,000,000; and35 80 full-time employees, psychiatry,socialwork, addictions,and traineesin psychology, counseling, includingan APA-approved clinical psychologyintemship. Leadresponsibilityfor accreditation for andregulatorycompliance behavioralhealthservices: JointCommission,Illinois Department of PublicHealth,Centersfor MedicaidandMedicareServices, Illinors Departmentof MentalHealthMedicaidRehabilitationOption@ule 132). PrivatePractice Chicago,IL o Clinicalpractice:Children,adolescents, adults . Consultation to business, healthcareandsocialserviceorganizations, schooldistricts,andreligiousdenominations. Directorof AmbulatoryBehavioralHealth AdvocateRavenswood HospitalCommunityMentalHealthCenter,Chicago,IL Application - NASP Approved Provider Of Continuing profecsionatDevelopmetrt Page5 F. Evaluatiol l. Describethe method by which evaluationsare obtainedfrom participants. cl:ut'o,t.n.- ct+ 4e <t^'J Xite.w'tb-ta-,a {ezAba*'-al;;r,q,+ -4'z rr or*shoP; -- --- A coo-vse evaluatr!* .;tl be 2. Explain how your organization utilizes theseevaluationsfor future planning. th" tetAL^"F {vo^ 'Il'a eur*l^ariu,,4s !4.Tlt helT ue qtalna-te 4ne J h.lp + ll€ cc'\vte- r la*icllan+3! yedd+ov9f- +,a ro*vse, ,r,n, rgJeeS"t <l,o co".< # . ""rntton- C,Jqler^t .rs 3. Submit a sampleevaluationform and a summaryofthe evaluationsthat have be€n completedby participants for the three previously offered programsfor which you completedAttschmeot A forms. You may use thrce-blankivaluation forms oq which you may write the total numbers. G. Awarding Contsct Hours l. How do you veri$ an individual'sparticipationandcompletionof an activity? F1 Yu (r t''lparts \/,r)r^J (e ff.Llye +a 4lrerr- €wrve FiioJ att,*^* "l Alrev' p^Yn'(ilvrr,tts*r,rtshr\ ! $e aorLcl,'], do..r*""-p,,,da.'riar^ f al+anJ*^ e t" ol (acL cc*rle*;> artJ <,gvr-o'l t 61ai,a 4.J w\\ €tt5've voLeive a. ce'r+l{ttw+iav.,/ 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 I II L J No _ CD -9 o s o ttt o(E E .9 {, at o +, c, (, c(E ctt cn &. o-= boE (E.9 r- C) ",rj o, a \i cD 'b l_ @ tt, oo o +, I rF o g o +, (E +, F (l, F F o (D c= (I) (5 o o ct) (5 .9 C) (, .9. o) o o o) (D (n (o O -9. (o 6 J = o _c o, E (5 o o z. =r.\u lr) (\l =. C) >\ (tt o6 o (D _c o z. o o a _o <f) E o o c) .9 c) O o J o(J F E o) o oo(E =() EA Eq, rF I .F o_ U) L o z (J (E q J o o cl ..c o at, (J c(l, c.) i o o o o o tt OH O; e o- (t U' I ct) (D o E .E (E c(E = p o o o_ E oo E U' -:< l- .g (, ts |E o- o) E (D U) o .s2 J (E F .9 ct o) c o at) (D o_ o > > 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 ?e'lL\1ouot41Fhcvtlrct To EN{zoRE"tHE Aqrvrry Coill/uy r,t,r'rH-TFIF NASP PRNctpL€ s fuR PKoFe9tloArAL ErHl05. policy. . Describeyour cancellation/refund V€@ree rrtE woRKqto? wice >L W-re tr>ED loao/CANcB-5noNt\Jpro oNi ui*x (rt5-106 y2|)1tNE EcaNER T{AAJ 5 cAA,i T}iE wr,PK3:Ho , pA-v5 BETF{)CE ? Vo,u, EG Rguruuei> . 19"1" \oU HAYAL90 cr\o.rL To A?f{ louR Q+}rrrEN Tc L'fr):aq-- g1eet'a it\itTea,eoTI kEGrViNq * WlitJV, AIORE?rJNprwtu-Weqt1EN tF h)e.@ NoT Q:eEtVE a C/v\rLt L.Jrna\) lHE ers111 ro CAr$tLL-at l S69to,'! a<'R warLr,t 8g&u891 (+oU I,v\L fARn<-rPmrT. We EsFRreD rrEForutr rN rnE 3 i4FsgWFMI"ioLl r ae,!"fifl€l#,r1turF&$1!?[?frk9,"&fS"tff*"te*,ibi,a$E€J$F"f"rioof"% al.lolecls'"t',"cff:Jtjfl'r,:Nr!, ls ^ 1r;er!"14 t Sr +la Vz;ketl cu' +!t sTrle "t Prese"*r'+'o't,{.e ;^J ''iJq^l Aw'^+ - TL!' Dtett"t'"'( EPE v,r'll$ca Tals o in ^i -"$ln" E?€ *\r a. a'lleutt o. ? , ". r ai ^ lo hro,./{ lla p^rr'c -t qntJ to oorl ^r.orl,cr c r eJ , t { a. ' - < . J l; . , , ^ a d *, , F +h o p . c z 4. rherouo;ing'lt'er* *t,, B i'li8r[d{a t"JktHtfcr'h #*!#,:"rE -/ __L: L .!1 Educationalobjectives Scheduldagendaand format Cmcellationhefundpoliry Number of contacthours -y( _y _ Tatgetaudtence 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 2NLYCou-tL1 VovR pEtsg-1y\ r.- rNFoRflArr o,0 fs c.ri A< youi! i{A1.1b, A?PFES1, oF Tb:t4<o,rrE NuflbEt ) lF ycu pnouip6 iT vrLrilTqFru/. ws wrLiNdl rErA"'j lorrt ?tR1/u/J6.u6ft'Rt4A7(rp L c,rttE< 1H4/J /S NE(E3}A.Ry qaR ftE AoFA(E . n( wfttctl tf tS 7 oss-6a7gr, rA {fDr loai , *" po Aic 1- lELu /-I,EADF dF ENI pARrrci[615 'G oTttEes f:rrsc r.,lr+r-tNFCiQ./r1A{tiA or; rs >e. o-F orR EN.rrf\ a1i,1 ao R Ap\ ER1iz, rt1 fu"> pt;r,rcnep A4EN AiFy c CN J.,JLTAtu rg . c lE5 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 ! Pafticipant Name: Email Address: PleaseCheckOne Phone: ! General Admission ($85per session) ! SiteSupervisor/Community 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: CorporateEducation and Consulting Services TheChicagoSchoolof Professional Psychology 325NorthWells,Chicago, IL 60610 Yourregistration will be confirmedby email. Pleaseaddressinquiresto Consultino@thechicaooschool.edu. Totaldue: $ _ Formof payment: CE'sdesired: ! ! Check(attached,payableto The ChicagoSchool) ! Positive Psychology in theSchools LCSW fl LCPC CreditCard tr MFT TypeandNumber f] AODA AuthorizedSionaturefor CreditCard Date