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  Application for Providers of Continuing Education for Psychologists

Submit this form to create your organization's profile.
Then you will log into your profile to prepare the Board Approved CE Provider Activity Report.
You only need to fill out this form once. Then all information updates and reports can be done within your profile.

Eligibility

Part 3201 Chapter 12 Continuing Education

Rule 12.4: Criteria for Board Approved CE Providers: The following programs are eligible to apply to become approved providers of continuing education (CE) for licensed psychologists. Continuing Education from approved providers may be used to meet the biennial CE requirements for renewal status.

  • Mississippi Psychological Association
  • Predoctoral Internship Programs and Postdoctoral Fellowship Programs in Mississippi which are accredited by the American Psychological Association (APA)
  • Graduate Training Departments of Psychology with APA Accreditation

Any CE credits obtained from programs approved by the APA to provide CE automatically qualify as approved by the Board.


APPLICATION PROCESS

The application consists of a proposal describing various aspects of the continuing education program. Attachments of supplemental materials (such as announcements, attendance rosters, evaluation forms and certificates of completion) where noted are required. You may attach additional pages, if necessary.

1. Name and Type of Organization: Identify and describe the organizational structure (specific division/department) responsible for providing continuing education for psychologists.
Organization Name:
Type:
2. Organizational Mission: What are the overall missions of the organization and the major goals of the specific department/division applying for continuing education provider status?
3. Target Audience: Indicate all groups you plan to target as potential attendees.

        
        
        
   (Specify)    

4. Administrator of Continuing Education Program: (Should coordinator/director/contact person change, you are responsible for providing this information to the Board as soon as possible)

Title First Name Middle Last Name Suffix

BUSINESS ADDRESS:
  Street City State Zip code

PHONE: FAX:

EMAIL ADDRESS:
            Password:
Your email and password will be used to login to your profile to prepare your Board Approved CE Provider Activity Report.

Upload Vita:
Upload a PDF of your vita that is no more than 2Mb.
5. Goals: List the major goals of your continuing education program.
6. CE Committee Structure: Describe responsibilities, record keeping, and decision making processes of the CE committee. Provide a list of names of those serving on your CE committee.
7. Administration, Planning and Development of CE Activities: Describe how you would determine training/educational needs, program selection, instructional personnel, and curriculum content. How you financially support CE activities?
8. CE Activity Evaluation: Provide a sample form that demonstrates how you evaluate the following: participant satisfaction, program content, instructor performance, program effectiveness, facilities, achievement of learning objectives
9. Co-Sponsorship Policy and Procedures: Do you co-sponsor CE activities with other organizations?
    
If yes, upload the policy and procedures used for co-sponsorship.
Please note you are still responsible for ensuring the CE activity meets quality standards and requirements.
PDF must be less than 2Mb.
10. Standards for Awarding Credit: Describe how you will track attendance and determine credit.
11. Sole Responsibility: Provide evidence that the approved provider shall be solely responsible for the CE activities under their sponsorship or co-sponsorship. CE approval status shall be indicated on publicity materials and certified by the following notation: {name of organization} has been approved by the Mississippi Board of Psychology to offer continuing education activities for the purpose of meeting State licensure requirements.

Please attach a sample.
PDF must be less than 2Mb.
12. Self-Review Plan: Describe your CE program’s periodic self-review plan. How will you collect and review participant feedback?
13. History of Providing Postgraduate Training, if any: If your organization has provided continuing education activities in the past, please give a brief history.
   


INSTRUCTIONS:
When you submit this form you will be taken to a screen with instructions to login to your profile.







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