Please insert the demographic information on your application up to the line “ **Please list only ONE Discipline…”. Please search the sections which follow below in order, inserting the information as requested. Review the Required Information Checklist, organize all documentation, complete the application form and review your submission. We Guarantee Privacy, Confidentiality and Security of you information—exceptions are mandatory reporting criteria and court ordered subpoenas.
 

Precision in Representation:  Selecting Your Discipline and Specialty Areas

Precision in representation with the professional and general public is an essential to developing an alliance.  To that end, selecting a sole division of practice is a necessary but insufficient act toward precision in representation.  Therefore, we request that, in addition, you select at least one specialty area to further define and clarify your scope of expertise.  Please select from the lists below only one Discipline (per certification) and one or more Specialty Areas (per certification) and place them on your application.  Regarding your area(s) of specialty, we list some examples below for the sake of clarity, however, we invite you to identify and define areas outside those listed.

 Disciplines:  Review this list and select ONE area to be listed on your application.

       Psychology, Psychiatry, Nursing, Social Work, Counseling, MR/DD, Addictive Disorders, Alcohol/Chemical Dependency, Voc. Rehab., Education Grad., Undergrad Ed., Forensics, Criminal Justice, Law Enforcement, Probation, Parole, OTHER

 Specialty Areas:  Review this suggested list and select at least one area to be listed on your application.

     Examples:  Clinical—Supervision, Assessment, Treatment, etc.; Addictive Disorders; Education—Teaching, In-service Training, etc.; Pharmacology, Forensics—Investigation, Court Evaluation-Competency-Custody, Civil Matters, Mediation, Licensee/Certification—Competency-Evaluation-Examination-Ethical Evaluation, Research & Publications, OTHER
 

Certification Titles

The certification title represents two elements within your Domain of Practice and it is determined by two pieces of information on your application— your chosen Discipline (e.g., Psychology) and selected Service Area/s (e.g., Clinical Supervisor).  For example, the title of Certified Clinical Social Work Supervisor reflects the Discipline—Clinical Social Work and the Service Area—Clinical Supervisor.  Clearly, in certain instances rules of speech and grammar necessitate additions, omissions, changes and juxtapositions of full title elements.  The titles below reflect only those which are most frequently sought and/or currently approved.*  If you do not locate a title by the combination of your Discipline and Service area, please go to our website—search certification titles, and if not located call our offices for assistance.

Please place your selected certification title(s) on the application and your cover letter.

 Note:  Where a backslash (/)appears select either descriptor (i.e., Clinical or Forensic, or, Chemical or Alcohol).

 Certification Titles