A. Submitter Information
Official authorization notice will be emailed to the below email address. The submitter listed below will be contacted by the Collaborative if there are any questions about the application form.
B. Sponsor Information
List the name of the
sponsoring organization or individual below. If you are an individual sponsoring a program Submit these items below. independent of any organization and this is your FIRST time applying online, you MUST submit a resume and two letters of reference regarding your qualifications and relevant experience.
Briefly describe what kind of work the sponsor does.
Has your organization been approved as a continuing education provider or had program approval with other professional associations?
If yes, list the full titles of the organizations below.
Has your organization been denied approval as a continuing education provider or had a program denied approval?
Yes No Listing more than one date in the following field means participants must attend all dates to receive credit. If the same program is being repeated on additional dates, submit Notice of Repeat Use after the course has been approved.
learning (not teaching) objectives below.
Type the schedule of
teaching hours with EXACT TIMES below. Do NOT include introductions, breaks, lunches, CE stamping, or time spent completing evaluations.
NOTE: A fifteen minute break is required per 3 hours of instruction time. Working/Instructional hour lunches only count for 0.5 CEs as participants need at least 30-minutes to eat. NOTE: For larger, multi-workshop conferences, upload a detailed program brochure and type "see brochure" in the schedule field below. Total the above teaching hours. CEs will be rounded down to the nearest whole or half number.
Select the program's targeted social work practice levels.
Advanced Practitioner Intermediate Practitioner Beginning Practitioner
Select the instructional methods utilized during program.
Lecture via workshop/seminar Case presentation Discussion groups Audio/Visual Other (specify below)
Describe how the course content applies to clinical and/or macro social work practice.
List three (3) books or articles of reference from the bibliography.
D. Instructor Information
In the box below, type the following information for EACH instructor.
Number each instructor.
Degrees and License
Brief description of Relevant Experience – No more than one paragraph per instructor. (DO NOT COPY AND PASTE RESUMES INTO THIS BOX.) Note: If you uploaded a program brochure with this information, type "see brochure" below.
The evaluation form MUST list the program’s learning objectives in order to ascertain that teaching goals have been reached. Evaluation must be specific, written and measurable, and reflect the following areas:
(individual objectives must be rated) Course appropriateness to participant’s education, experience and licensure level
Relevance to professional practice and currency of information
Instructor’s knowledge of subject matter and responsiveness to participants
(if applicable) Was subject matter presented effectively and clearly?
Instructor’s ability to utilize course-appropriate technology to support participant learning
(if applicable) Suitability and/or usefulness of instructional materials
Location, facilities, and technology
Administration of the program
Timeline of course adhered to the advertised
We have an evaluation form for this program that meets the above requirements.
F. Attendance & Assigning CE Credit
The MA Board of Registration expects programs to achieve the highest standard of 100% attendance for a participant to receive credit. There may be extenuating circumstances which would allow for leaving at 80%. No partial credit is to be given.
As the approved sponsor, you are responsible for the creation and distribution of the certificates of attendance to participants who complete the program. Certificates MUST have the participant’s name on it before it is stamped/authorized and given out.
When programs have been approved, only those individuals who satisfactorily complete the program will receive credit for attendance. It is the sponsor's responsibility to document that the participants met this standard.
Examples of monitoring attendance include: participant sign-in/sign-out sheets, use of electronic name badge readers, and the issuing of unique session codes to participants at the conclusion of programs, or at each session.
Describe how you verify and monitor attendance, as well as the process for issuing certificates of attendance.
Are you submitting this application on or after the program date listed in Section C? (If multiple dates are listed in Section C, use the final program date.) Yes. (There is an additional $25 late fee per each late application.) No.
Please note that application(s) will NOT be reviewed until payment has been received by the Collaborative.
How are you paying for this form?
I am paying online with a credit card. I am sending payment via mail.