April 2018 Thank you for your interest in obtaining continuing education credit for your event/workshop from the Oregon Chapter, NASW. Please refer to the Program Application Criteria in this packet to assist you in understanding the level of conference content and relevant social work topics if needed. The state of Oregon requires social workers practicing at the bachelors, masters and clinical/lcsw social work levels to seek licensure and continuing education. The NASW of Oregon certifies conferences and workshops in the continuing education categories of non-clinical, clinical, ethics and supervision. Please see the State Board of Licensed ers Oregon Administrative Rules Chapter 877 at http://www.oregon.gov/blsw/pdfs/12_29_2011_final_rules.pdf Please complete the following Application for Professional Continuing Education Credit, including Attachment A: CEU Application Worksheet in its entirety. The CE application fee is different for profit and non-profit sponsors and is graduated according to the number of hours approved. Please call the office to discuss this non-profit rate or with questions. NASW will send an invoice to you. The CE application fee for a profit sponsor is: $190 for 1-7.5 CE hours; $280 for 8-16 CE hours, $400 for 17-25 CE hours, $450 for 26-55 CE hours, $500 for 56-99 CE hours, $630 for 100-150 hours and $790 for 151-200 CE hours. For a non-profit sponsor who is not charging for the conference, the CE application fee is: $95 for 1-7.5 CE hours, $140 for 8-16 CE hours, $200 for 17-25 CE hours, $225 for 26-55 CE hours, $250 for 56-99 CE hours, $315 for 100-150 and $345 for 151-200 CE hours. Please send applications by e-mail to Janet Kusyk at jk.naswor@socialworkers.org. Authorization typically takes four to six weeks from receipt of a completed application. A $75.00 rush fee will be added to any application needing authorization in less than 4 weeks time. The Chapter will review your application and contact you by e-mail with its determination. If your conference is approved, you will need to have attendees requesting CE credit complete an NASW conference evaluation form and sign a conference roster indicating their completion of the conference. Your approval letter, CE certificates, evaluation forms and conference roster will be e-mailed to you approximately two weeks prior to your event, time permitting. Your forthcoming approved conference/workshop will be posted on the NASW Oregon Web site if you request it on your application. If you wish to repeat this workshop (same speaker, content, etc.) within 12 months, there is a per repeated workshop fee of $50 for nonprofits and $80 for profit sponsors. Email Jk.naswor@socialworkers.org with your request. It is the responsibility of the event/workshop sponsor to mail (no e-mails or faxes) attendance rosters and evaluations to the NASW office (2929 SW Multnomah Blvd., Ste. 305, Portland, OR, 97219) upon completion of the training. NASW will maintain these documents in its chapter files. Please destroy any unused CE certificates. Again, we appreciate your interest in the NASW Oregon Chapter s Continuing Education Program. Please contact our office at (503) 452-8420 if you have further questions. Sincerely, Janet D. Kusyk Janet D. Kusyk. Continuing Education Coordinator, jk.naswor@socialworkers.org
Application for Professional Continuing Education Credit Revised April 2018 For office use only: No. Fee $ Date Rec. / / PDF / / or E-mail / / Data Entry / / Date Paid / / Please save this as a Microsoft Word document or PDF and send via e-mail to Jk.naswor@socialworkers.org. Please type or print legibly. Date of Application Prepared by Email address Title of Event Sponsor(s) Event Date(s) Event Times Repeat Date(s) Repeat Event Times Event Locations(s) City State Target Audience Will there be a registration fee(s)? Yes No Registration Fee(s) $ Registration Telephone Web site E-mail for registration inquiries Estimated number of attendees Total estimated number of CE hours requested for approval. Is this an "in service" (not open to other social workers) event? Yes No Do you request this event be listed on the NASW Website if time permits? Yes No 1. If diversity, cultural competence, social justice and/or anti-oppressive practice will be addressed, please describe how.
2. Attach a brief agenda (including breaks and lunch) that includes dates and time frames for each agenda item or send a training flyer/brochure that carries this required information. 3. Attach a short paragraph (DO NOT send resumes) on each presenter describing the presenter's qualifications to present on his or her topic. Please include name, title, degrees, current and former work experience in topic area, etc. 4. Complete all information requested on Attachment A: CEU Application Worksheet 5. Please feel free to send additional information as a Microsoft Word document or PDF. Have you determined that the physical facilities for this event are ADA compatible for participants? Facilities are ADA compatible Not ADA compatible or undetermined as of this date Please add any further information that would be valuable to the CE Committee. Name/address of person to whom the CE certificates should be emailed: Name Organization Address City State Zip E-mail Phone ( ) Fax ( ) Name/address of person to whom the invoice should be emailed: Name Organization Address City State Zip E-mail Phone ( ) Fax ( ) After completing this form, including Attachment A, the CEU Application Worksheet, please e-mail both and any additional information to Janet Kusyk, jk.naswor@socialworkers.org. An invoice will be e-mailed. Rush Fee Notice: Authorization typically takes four to six weeks from receipt of a completed application. A $75.00 rush fee will be added to any application needing authorization in less than 4 weeks time. Application fees and payment information on next page.
Application Fees and Payment Information: Profit Sponsor Fees For a profit sponsor: $190 for 1-7.5 CE hours; $280 for 8-16 CE hours, $400 for 17-25 CE hours, $450 for 26-55 CE hours, $500 for 56-99 CE hours, $630 for 100-150 hours and $790 for 151-200 CE hours. Non-Profit Sponsor Fees For a non-profit sponsor who is not charging for the conference the CE application fee: $95 for 1-7.5 CE hours, $140 for 8-16 CE hours, $200 for 17-25 CE hours, $225 for 26-55 CE hours, $250 for 56-99 CE hours, $315 for 100-150 and $345 for 151-200 CE hours. Payment The chapter will send you an invoice for the application fee. Checks or money orders should be made payable to: Oregon Chapter, NASW and mailed to the chapter office, 2929 SW Multnomah Blvd., Suite 305, Portland, OR 97219. When sending additional material or a payment to NASW, the workshop s title and date should be clearly visible. Repeat Fee If you wish to hold this workshop again within 12 months of the workshop date, there is a per repeated workshop fee of $50 for nonprofits and $80 for profit sponsors. The chapter will email you an invoice. Please call the chapter office at (503) 452-8420 for questions or information. Incomplete applications will not be processed until all information is received. Revised April 2018
Attachment A: CEU Application Worksheet Training Title: Training Date(s): Worksheet Completed by: Tele. Email Page 1 of 1. Provide the start and end time for each workshop. 2. Non-Clinical Practice CEUs Number of hours with content pertaining to the practice of social work in general. 3. Clinical Practice CEUs Number of hours with content pertaining to the prevention, assessment, treatment or diagnosis of mental disorders. See page 2 of the Program Application Criteria for more information. 4. Ethics CEUs Number of hours with content pertaining to ethics, laws and administrative rules of practicing social work. 5. Supervision CEUs Number of hours with content pertaining to supervising the practice of social work. 6. Learning Objectives State how each workshop meets the objectives of each workshop s content. Time frame for each workshop 1 (Do not include time for introduction, breaks or lunch break) Speaker/Credentials/ Licensure Workshop Title & Brief Description Non-Clinical Practice # of CEUs 2 Clinical Social Work Practice # of CEUs 3 Ethics # of CEUs 4 Supervision # of CEUs 5 Learning Objectives 6 Attachment A: CEU Application Worksheet Page 2 of
Training Title: Training Date(s): Worksheet Completed by: Tele. Email 1. Provide the start and end time for each workshop. 2. Non-Clinical Practice CEUs Number of hours with content pertaining to the practice of social work in general. 3. Clinical Practice CEUs Number of hours with content pertaining to the prevention, assessment, treatment or diagnosis of mental disorders. See page 2 of the Program Application Criteria for more information. 4. Ethics CEUs Number of hours with content pertaining to ethics, laws and administrative rules of practicing social work. 5. Supervision CEUs Number of hours with content pertaining to supervising the practice of social work. 6. Learning Objectives State how each workshop meets the objectives of each workshop s content. Time frame for each workshop 1 (Do not include time for introduction, breaks or lunch break) Speaker/Credentials/ Licensure Workshop Title & Brief Description Non-Clinical Practice # of CEUs 2 Clinical Social Work Practice # of CEUs 3 Ethics # of CEUs 4 Supervision # of CEUs 5 Learning Objectives 6 Attachment A: CEU Application Worksheet Page 3 of
Training Title: Training Date(s): Worksheet Completed by: Tele. Email 1. Provide the start and end time for each workshop. 2. Non-Clinical Practice CEUs Number of hours with content pertaining to the practice of social work in general. 3. Clinical Practice CEUs Number of hours with content pertaining to the prevention, assessment, treatment or diagnosis of mental disorders. See page 2 of the Program Application Criteria for more information. 4. Ethics CEUs Number of hours with content pertaining to ethics, laws and administrative rules of practicing social work. 5. Supervision CEUs Number of hours with content pertaining to supervising the practice of social work. 6. Learning Objectives State how each workshop meets the objectives of each workshop s content. Time frame for each workshop 1 (Do not include time for introduction, breaks or lunch break) Speaker/Credentials/ Licensure Workshop Title & Brief Description Non-Clinical Practice # of CEUs 2 Clinical Social Work Practice # of CEUs 3 Ethics # of CEUs 4 Supervision # of CEUs 5 Learning Objectives 6 Attachment A: CEU Application Worksheet Page 4 of
Training Title: Training Date(s): Worksheet Completed by: Tele. Email 1. Provide the start and end time for each workshop. 2. Non-Clinical Practice CEUs Number of hours with content pertaining to the practice of social work in general. 3. Clinical Practice CEUs Number of hours with content pertaining to the prevention, assessment, treatment or diagnosis of mental disorders. See page 2 of the Program Application Criteria for more information. 4. Ethics CEUs Number of hours with content pertaining to ethics, laws and administrative rules of practicing social work. 5. Supervision CEUs Number of hours with content pertaining to supervising the practice of social work. 6. Learning Objectives State how each workshop meets the objectives of each workshop s content. Time frame for each workshop 1 (Do not include time for introduction, breaks or lunch break) Speaker/Credentials/ Licensure Workshop Title & Brief Description Non-Clinical Practice # of CEUs 2 Clinical Social Work Practice # of CEUs 3 Ethics # of CEUs 4 Supervision # of CEUs 5 Learning Objectives 6