Continuing Education Rush Provider Application - National Association of Social Workers Texas

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Continuing Education Rush Provider Application

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Please review the NASW/Texas Guidelines for Granting Continuing Education Hours. You are required to fill out this Continuing Education Rush Application because you are submitting your application information less than 6 weeks prior to your program. Applications for continuing education will not be reviewed until all information is included on the application below. This application must be accompanied by appropriate $60 application fee before it will be reviewed.

An EXPRESS FEE of $50 will be charged in addition to the $60 Rush Application Fee, if approval is needed 7 business days or sooner from the date of the event. This additional fee will be charged before it will be reviewed (if applicable).

Make sure to complete the Education Documentation form and gather CVs prior to starting the application process.

Download an Education Documentation form sample.
Download a blank Education Documentation form template as a Word document.

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Part I. Applicant Information
Organization Name *
First Name		Last Name *
Title *
Phone *		Email *
Address *
Address Line 2
City *		Zip Code *
Website

Part II. Program Information
Title of continuing education program *
Indicate the proposed date(s), times and location of your program.
Only the first row is required. Each application is approved for up to four dates for the same seminar as long as all four dates are indicated on the original application and are scheduled within a calendar year of original submission. Another application must be submitted for additional dates
(1) Date and Time *		(1) City, State *
(2) Date and Time		(2) City, State
(3) Date and Time		(3) City, State
(4) Date and Time		(4) City, State
Describe your system for selection and supervision of qualified instructors. *
Describe how your organization selects the topics for its programs. *
Are there any co-sponsors of this program? *	Yes No	If yes, please list:
Who is the target audience for your program? *		List the expected number of participants. *
Instructor(s) Name(s) *
Has the instructor ever had disciplinary action taken against his or her professional license? *Please note that affirmative answers to this questions may result in denial of program approval.	Yes No	Has the instructor been convicted of a crime related to their professional practice? *Please note that affirmative answers to this questions may result in denial of program approval.	Yes No
Statement of how course is related to or enhances the practice of social work. *
Disclaimer:
Per the forthcoming rules, continuing education that was previously identified as “Cultural Competency” is now labeled “Human Populations.” The breadth and scope of the topics remain unchanged.
Total Number of Hours requested. *
Number of Ethics Hours requested. *Enter 0 if no ethics hours requested.		Number of Supervision Hours Requested. *Enter 0 if no supervision hours requested.
Number of Human Populations Hours requested. *Enter 0 if no Human Populations Hours requested.
For Ethics Approval
The workshop must reflect a majority of the six ethical standards listed in the NASW Code of Ethics including Service, Social Justice, Dignity and Worth of the Person, Importance of Human Relationships, Integrity and Competence. Background of presenter should reflect competence in ethical training. Workshop must demonstrate relevance to social work practice. Workshop should allow time for discussion of implications for social work practice.
For Supervision Approval
The workshop/presentation must address one or more elements found in the Texas State Board of Social Worker Examiners supervision course content guidelines. The workshop/presentation should enhance recipient’s professional knowledge and skill about supervision so that they can successfully engage supervisees. The workshop/presentation should have specific objectives that relate to supervision of social work supervisees. The background of the presenter should reflect competence in supervision, as is evident in the presenter’s bio and/or CV.
For Human Populations Approval:
The workshop/presentation should focus on cultural diversity or competency. This should include, but is not limited to, continuing education regarding age, disability, ethnicity, gender, gender identity, language, national origin, race, religion, culture, sexual orientation, and socio-economic status. The workshop/presentation should enhance recipient’s professional knowledge and skill about cultural diversity or competency, or their own identity as it relates to these topics. The workshop/presentation should have specific objectives that relate to cultural diversity or competency. The background of the presenter should reflect knowledge about how cultural diversity or competency impact social work values and practice, as is evident in the presenter’s bio and/or CV.

Part IV. Participation Agreement
Continuing Education Participation Agreement Checklist
As a provider of a continuing education event with approval from NASW, I agree to: Submit a fully completed application with $50 fee at least 6 weeks before program, and an additional $10 RUSH FEE if prior to 6 weeks. If approval is needed 7 business days or sooner from the date of the event, an EXPRESS FEE of $50 will be charged in additional to the $60. This additional fee will be charged before it will be reviewed (if applicable). Fully explain the Attendance Verification Form to the workshop attendees and emphasize that they will not receive certificates if their forms are not correctly and completely filled out. Submit ONE LUMP SUM Check with the Attendance Verification Forms ($10.00 per form) within thirty (30) days of the event. Please allow at least six weeks following submission of the forms for the NASW/Texas Chapter office to complete processing. Submit a sign-in sheet with the Attendance Verification Forms. (Templates for these forms will be provided upon approval.) Submit a copy of the original approval letter from NASW/Texas when submitting the Attendance Verification Forms and Sign-In Sheets. Comply with the NASW Standards for Assessing Providers of Continuing Professional Education and affirm that my organization has: A means of responsibility for control over all aspects of programs to ensure that educational objectives and standards are met. A system for selection and supervision of qualified instructors. Taken into consideration social work values knowledge and practice in the planning and evaluation of the program. A system for evaluation of programs by participants. Not discriminate in selection of participants by reason of sex, age, race, ethnic background, sexual orientation, or other characteristics. I agree to all other conditions stated in the NASW Guidelines for Continuing Education Approval.
I have read and agree to the above CE Particpation Agreement. *Applications with "No" indicated in this field will not be reviewed.	Yes No
Does your event require immediate approval at least 7 business days prior to the event? *By checking YES, this acknowledges that your event will require approval 7 business days or sooner from the date of the event and an additional fee of $50 will be charged in addition to the $60 rush fee. This additional fee will be charged before it will be reviewed (if applicable).	Yes No

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