CONTINUING EDUCATION PROVIDER APPLICATION AND DOCUMENT CHECKLIST
All applicants must adhere to the following guidelines: Please print this checklist and include it with your
application. Your application and all documents must be sent in one packet. Failure to provide all of the
required documentation will delay the review of your application.
_____ Application is completely filled out and submitted 60 days prior to the course date.
_____ Two copies of all original documentation including the application and required documents are sent in
one packet.
_____ Appropriate fees are included with completed application
_____ Instructors are qualified to offer a continuing education course and that the presenter’s Bio/Resume/CV
is included with the application packet.
_____ Course content is relevant to social work, theory, methods, and practice. Please refer to course ‘rubric’
that is the second page of this checklist.
_____ A syllabus/course outline will be made available to participants at the beginning of each course and is
also included in the application packet.
_____ A blank course evaluation form that will be given to participants is included with the completed
application packet.
_____ A blank Sign In/Sign Out sheet with space for SW License Numbers is included with application packet.
_____ Sample Certificate of Attendance that you will provide to participants must be included with the
application packet. Certificate must have the following information on it:
Attendees Name
Title, date, location of course
Instructor’s name and credentials
Number of continuing education hours earned
MICEC approval statement with course approval number
_____ In promoting approved course, brochures, flyers, etc. must include (if applicable):
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Educational goals and objectives
Course target audience
Targeted social work practice levels
Instructors and their credentials
Course fees, including what is covered, deadline for cancellations and refunds
Course syllabus or agenda
Continuing education hours offered
Clear information about jurisdictional approvals and specific CE requirements
ACE provider number, approval statement and expiration date (if applicable)
Instructions for requesting ADA accommodations
Course completion requirements
Statement of when and how certificate will be given
Where both educational and non-educational sessions are offered, the courses for credit must be clearly
identified
Instructions for addressing grievances; contact information
Once the course has been approved and conducted, you must comply with the following rules:
_____ CE providers must keep a copy of all course documentation, evaluations and attendance records for a
minimum period of four years.
The following is the MINIMUM STANDARD for courses submitted to the Continuing Education Collaborative for review.
You are welcome and encouraged to provide course work at a more advanced level than listed, but all courses must at
least include information from one of the Content Areas AND the Required Information below.
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Content Area
Theories & concepts
of human behavior
in the social
environment
Social work practice,
knowledge and skills
Social work
research, program
evaluation, or
practice evaluation
Social work agency
management or
administration
Development,
evaluation, and/or
implementation of
social policy
Social work ethics
and standards or
professional practice
Pain/Pain symptom
management,
including but not
limited to, behavior
management,
psychology of pain,
behavior
modification and
stress management.
Required
Information
Presenter
credentials are
relevant to course
presentation
References are
relevant
Minimum Standard
Course includes SKILLS OR KNOWLEDGE in ONE OR MORE OF
biological, psychological, sociological, and spiritual approaches to Person-inEnvironment and systems theory concerns.
Course is characterized by presentation of either THEORETICAL
FOUNDATION FOR SKILLS OR PRACTICE WISDOM with individuals,
families, and groups without demonstration or assessment.
Course is characterized by presentation of practical skills in THEORETICAL
FOUNDATION FOR SKILLS OR PRACTICE WISDOM of research, program
evaluation, or practice evaluation without demonstration or assessment.
Course is characterized by presentation of practical skills in THEORETICAL
FOUNDATION FOR SKILLS OR PRACTICE WISDOM in supervision,
management, and administration without demonstration or assessment.
Course is characterized by presentation of practical skills in THEORETICAL
FOUNDATION FOR SKILLS OR PRACTICE WISDOM in social policy
analysis and/or implementation without demonstration or assessment.
Course is characterized by explicit reflection on standards of professional
practice in social work or related to social work ethics.
Course is characterized by presentation of practical skills in THEORETICAL
FOUNDATION FOR SKILLS OR PRACTICE WISDOM in AT LEAST ONE of
behavioral, psychological, and biological methods for pain and pain system
management without demonstration or assessment.
Course is characterized by presentation of practical skills in THEORETICAL
FOUNDATION FOR SKILLS OR PRACTICE WISDOM in methods of
behavior modification and stress management without demonstration or
assessment.
Required Standard On All Applications
Presenter credentials are relevant to course presentation including AT
LEAST ONE of education, publication, OR practice experience in the subject
area, OR social work planning or consultation.
Bibliography consists at least 50% of references from the last 5 years as well
as seminal primary source works germane to the course.