CCAT Application

Certified Clinical Adventure Therapist (CCAT)

Credentialing Application
CCAT Tutorial Video
Youtube
PLEASE READ BEFORE BEGINNING YOUR APPLICATION.

Applicant:

We require the below document to be downloaded and filled out by your supervisor(s). Once the document has been filled out, please upload the document when prompted within the application. You may submit more than one copy if you have more than one supervisor.

You must ensure you have met all the below criteria for hours before submitting this form. If you received supervision from more than one supervisor each supervisor must complete a separate form. Each supervisor should indicate only the dates and hours for which s/he provided supervision. All forms from all supervisors combined should total the minimum hours required.
DOWNLOAD AND SEND TO SUPERVISOR(S) BEFORE BEGINNING YOUR APPLICATION. (Hover cursor over black box below and click the down arrow to download)
Credentialing Application Overview
This PDF summarizes the criteria that applicants must satisfy to earn the Certified Clinical Adventure Therapist (CCAT) credential. The criteria are designed to ensure that candidates possess a well-rounded education, and training in Adventure Therapy. (Hover cursor over black box below and click the down arrow to download)

CCAT Applicant Information
Name*

First NameLast Name
Employer*
Position Title*
Phone Number

Country CodeArea CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload a copy of your Professional Resume / CV here:*

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VERIFICATION OF GRADUATE DEGREES

Explanation: Master's or higher mental health, social services, or social sciences degree from an accredited institution of higher education.
Attach a copy of your graduate transcript(s) issued by an institution of higher education.

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Master's Degree In:*
Institution Name*
Year*
Doctorate Degree In:
Institution Name
Year

VERIFICATION OF LICENSE OR REGULATORY PERMISSIONS

Explanation: Current and active permission to legally and independently provide clinical mental health or school-based services in your region, state, province, or country in which you practice.
Attach a copy of your current, active, and unconditional regional, state, provincial, or country mental health license/document indicating you are permitted to independently provide clinical mental health services or documentation indicating you may practice within schools in your state.

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Please list your current licenses below:*

Verification of Direct Adventure Experience
Applicant:

We require the below document to be downloaded and filled out by your supervisor(s). Once the document has been filled out, please upload the document below. You may upload more than one copy if you have more than one supervisor.

You must ensure you have met all the below criteria for hours before submitting this form. If you received supervision from more than one supervisor each supervisor must complete a separate form. Each supervisor should indicate only the dates and hours for which s/he provided supervision. All forms from all supervisors combined should total the minimum hours required.
- Completion of 300 direct service hours of adventure therapy specific experience accumulated over a minimum of 90 days.
- In addition to the 300 direct service hours, applicants must complete at least 50 supervision hours of adventure therapy provision verified by the supervisor. Supervision must be distributed throughout the direct client hours and can be conducted individually or in a group setting.
- Total Hours of Adventure Therapy Experience: 300 direct service hours + 50 supervised hours = 350 total hours of experience.
(Hover cursor over black box below and click the down arrow to download)
Upload verification here (filled out by supervisor(s)

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VERIFICATION OF ADVENTURE THERAPY TRAINING

Training hours should be reasonably distributed across all core elements. While a single training can account for experience in multiple core elements, CCAT candidates are required to articulate how those training hours are distributed. For example, if a 2-hour training covers both ‘therapeutic alliance building’ and ‘facilitation and processing,’ it must be clearly stated how much time from that training was used on each core element. Explanation: At least 75 hours of adventure therapy-specific instruction covering all components of the “Core Elements of Adventure Therapy Training” (below). A maximum of twenty-five (25) hours may be virtual or online. This instruction should be provided by institutions of higher education (documented with the course syllabus) or from other professional development trainings. If these trainings offer CEUs, a certificate of completion and course content can serve as evidence of training. If not, a program packet and curriculum detailing the information reviewed will suffice as evidence.
For definitions and examples of the Core Elements of AT Training, please review the document below. (Hover cursor over black box below and click the down arrow to download)
Please upload all proof of training documents here:

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Legacy Application Notice: If you will be using an addendum to explain your Adventure Therapy Training and experience, Please enter the word "Addendum" into the form below.
Please categorize your training documents to help us understand which core elements of training were addressed in which documents.*
TOTAL Hours of Training:

Please List Total Training Hours Within Each Category:

	Total Training Hours
Facilitation and Processing in AT
Organizational / Administrative Policies in AT
Conceptual Knowledge in AT
Therapeutic Alliance Building in AT
Assessment in AT
AT Interventions
Therapeutic Monitoring in AT
AT Documentation
Professionalism in AT
Socio-Cultural / Environmental Considerations in AT
TOTAL AT TRAINING HOURS

First aid and CPR Training

Certification at the appropriate level of first aid (or higher-level healthcare provision) and CPR by nationally or internationally recognized organizations specializing in healthcare, and emergency response, or healthcare training. Level of First Aid certification should be consistent with setting of practice (wilderness or front country).
Attach evidence supporting information entered below

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List Trainings and Locations:
Level of Certification and Expiration Date:

Addendum

AEE recognizes it may be difficult for seasoned practitioners to reconstruct training, education, and supervision records before October 5, 2020. In response, AEE invites CCAT candidates to complete this application to the fullest extent possible and attach a separate document (i.e. addendum) to explain any deficiencies. In this addendum, candidates must outline how the requirements of the CCAT certification have been met and why the candidate cannot provide records as outlined in this application.
Does your application require review as a "legacy period" application (as described above)?

Yes, I will attach an addendum explaining how I have met CCAT requirements and why I am unable to provide proof.No, I have proof of all CCAT requirements.
Optional: Upload addendum here:

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Certified Clinical Adventure Therapist Applicant - Acknowledgement and Agreement

REVIEW & SIGN BELOW
This acknowledgment and agreement must be read, understood, and signed by Applicant as a condition to Applicant’s certification as an adventure therapist by the Association for Experiential Education (AEE). Applicant acknowledges and agrees as follows:

Adventure therapy requires various skills to facilitate adventure activities, including, but not limited to, games and initiatives, low ropes courses, and high-level challenge and adventure activities (including challenge courses at height, rock climbing, paddling, and other outdoor adventure pursuits). Regardless of the type of adventure therapy activity, the primary facilitator of the activity should have training in the technical skills required to reasonably manage its risks, including the level of emergency medical training appropriate to the setting (front country or wilderness).

A primary facilitator must meet one or more of the technical skill conditions described below to lead adventure activities:
- Certified / Licensed – Hold certifications or licenses appropriate to leading the adventure activity and received from professional training organizations that follow professional and commonly accepted practices for their discipline and are consistent with the laws and regulations for the jurisdiction in which activities are conducted; or
- Professional Training – Have received appropriate adventure activity training from professional organizations that follow commonly accepted practices for their discipline. Examples include organizations accredited by the Association for Experiential Education, American Mountain Guides Association, Association of Challenge Course Technology, and Colleges and Universities; or
- Organizational Oversight - Training received is part of a program with commonly accepted risk management practices, staff training, and appropriate activity protocols.
I, Applicant, will:
- Comply with the terms of this Agreement, and uphold the ethical and legal standards of a mental health professional pertinent to the licenses/certifications I hold;
- Facilitate adventure therapy activities in a manner consistent with my competence and training;
- Reasonably ensure that technically competent instructors act as primary facilitators of the technical aspects of the adventure activities I offer if I am not certified or professionally trained and assessed as competent to facilitate.
I represent that information, statements, and documents which accompany my application for certification or renewal are accurate, including with respect to my experience, education, training, and expertise. I am solely responsible for the accuracy of such information, statements, and documents, and AEE is not responsible or liable for any inaccurate or misleading information.

My application includes copies of my primary, current, and active state license as an independent clinical mental health practitioner. I attest that there are no restrictions or conditions on my ability to practice under my license. To the best of my knowledge, there are no outstanding complaints regarding my services as a mental health professional. Further, should I relocate my principal place of business to another state, I will provide documentation to AEE of the new license before commencing practice in that state;

I agree to notify AEE if I immediately:
- Have any disciplinary action taken against me by an applicable licensing authority;
- Have my license suspended or revoked or a condition placed on my license;
- Am convicted of a crime related to my providing mental health services or a crime that would adversely affect the interests, effectiveness, reputation, or image of AEE;
- Voluntary relinquish my license.
Failure to report any of the four conditions described above may result in the denial or revocation of my AEE Certified Clinical Adventure Therapist (CCAT) credential.

I have read and am familiar with the AEE Certification Credentialing Manual and acknowledge and agree to the requirements of CCAT certification set forth therein.

I acknowledge and agree that certification as a CCAT by AEE is not intended to be, and is not a representation or promise by AEE of my knowledge or competency, in my profession or otherwise, and that such designation confirms only that information and documentation received (which is not independently verified by AEE) reflects that the education and training requirements of AEE have been satisfied. I have not and will not utilize the CCAT designation as my only or primary credential. I understand that on all professional documents, communications, and in all advertising issued by me or pertaining to me, the CCAT credentials must be accompanied by the academic degree and the license in a mental health field that establishes the type of mental health services I am qualified to offer;

I understand that if AEE receives a complaint against me, AEE will request that the complainant bring their concern to the overseeing body of the state license(s) I hold. After a formal resolution of the complaint, AEE reserves the right to take disciplinary action if it believes such is warranted.

I hereby agree to indemnify and hold harmless AEE from and against any and all claims, losses, actions, costs, and expenses, including attorneys’ fees and insurance deductibles, incurred by AEE as a result of or arising out of a) my acts or omissions in my treatment of patients; b) my failure to abide by the code of ethics, standards of practice and legal standards and requirements promulgated by my primary licensing authority; c) any falsification, including by omission or inclusion, of information on my CCAT application or any supporting documents; d) my conduct or actions that are prejudicial to the purpose, interests, effectiveness, reputation, or image of adventure therapy and/or AEE; and e) any other action or omission relating to my CCAT credential or my performance there under.

By signing below, I represent that all information entered on this application form and attached as part of this form is accurate. By signing below, I confirm my understanding of this Acknowledgement Agreement for the use of technical skills associated with adventure activities and agree to abide by its terms and understand that my failure to do so may result in the loss of my CCAT credential, rendering it null and void.
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CCAT Application Fee$90.00

Non-Refundable Application Fee. Once your application is approved, you will be billed $60 annually to maintain your certification. You will be directed to PayPal when you click submit. If you do not have a PayPal account simply choose "Pay with Debit or Credit Card".

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Certified Clinical Adventure Therapist (CCAT)

Credentialing Application Overview

CCAT Applicant Information

VERIFICATION OF GRADUATE DEGREES

VERIFICATION OF LICENSE OR REGULATORY PERMISSIONS

Verification of Direct Adventure Experience

VERIFICATION OF ADVENTURE THERAPY TRAINING

First aid and CPR Training

Addendum

Certified Clinical Adventure Therapist Applicant - Acknowledgement and Agreement

Application Fee Payment