MaMHCA/MCEAP Application for CE Providers

Complete this form to begin the application process, please note additional information for programs:

  • using Virtual Platforms
  • using both virtual & in-person platforms
  • with Multiple Break Outs
  • offered as a Series of Workshops

 

Please submit application information at least six weeks prior to each program.

  • Applications will not be reviewed unless payment and all requested information are received.
  • Allow 4 to 6 weeks to be notified of the program status.
  • Notification will be delivered to the contact person of record via email   

Save & Return

Create a Save & Return account to return to THIS APPLICATION ONLY. Do not use this feature for a new application.

A. Program Information Overview

2b. Has your organization been approved as a continuing education provider or had program approval with other professional associations? *
 
2c. Has your organization been denied approval as a continuing education provider or had a program denied approval by a professional association or other organization? *
 
6a. Is this a request to repeat a program? *
8. Program Type: Please identify the format of the program and complete the corresponding details below
8a. Single Presentation *
8b.Conference with multiple breakouts? *
8c. Workshop series? *
8d. Distance Learning? (You must also fill out Question #23 for each Distance Learning event.) *
9. Is there a charge for this activity? *
9a. Attestation of cancellation policy, refund policy, and grievance procedure. *
10. Total number of instructional hours? Please note: All CE events are considered as one Category.
11. Attestation: I certify that the information I have provided is accurate. I agree to comply with the ACA and AMHCA Code of Ethics regarding the offering of activities and the requirements set forth in this application *
10/500 characters
14. Indicate target audience for your program: (Please check as many as apply) *
 
14a. Instructional methods utilized during program. Check all that apply. *
 
14b. Type of distance learning program:. Check all that apply. *
 
10/500 characters