Maine Prevention Certification Board Education Form for Undocumented Events: Certified Advanced Prevention Specialist (PS-A)

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Maine Prevention Certification Board Education Form for Undocumented Events: Certified Advanced Prevention Specialist (PS-A)

This form is to be used to verify undocumented education.

If you do not have certificates for one or more workshops, you must fill out this form and have your supervisor or program director verify that you have attended these workshops (instructions are shared near the end of this form). Only 15% (8 hours for initial certification and 6 hours for recertification) of total education can be applied with this form.

PREVENTION ETHICS TRAINING MUST BE DOCUMENTED, AND MAY NOT BE LISTED ON THIS FORM.

You should make every effort to locate missing verification of educational hours before using this form. This form can also be used to document in-service trainings. Further detail about education documentation is included in the Maine Prevention Certification Manual, which can be found HERE.

NOTE: Google Forms automatically saves your progress for 30 days when you're signed in to your Google account so you can work across devices or take a break without losing a step.

Email *

Applicant's Name: *

Clear form

Never submit passwords through Google Forms.

This form was created inside of AdCare Maine. Report Abuse

Forms