CE Application - Revised

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Application for Approval of Continuing Education Training Program

Completion of this online application requires payment by credit card (service charge will be applied). To pay by check/money order, download the Application and Course Content Form and mail it to the Board office.

Information related to continuing education requirements in Nevada may be found at Nevada Administrative Code Chapter 641.
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Person Submitting Application
Name
Email Address
Work Phone
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Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
United States
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Program Details
Sponsoring Organization
Title of Program
Date of Program
Time of Program
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Program Details, Cont.
Location of Program
Maximum Enrollment (if any)
Number of Contact Hours (exclude breaks)
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Subject Area (Check all that apply):
Scientific and professional ethics and standards
Forensic Issues
Research designand methodology
Tests and measurements
Psychotherapeutic techniques
Biological basis ofbehavior, including physiological psychology, comparative psychology,neuropsychology, human sexuality, and psychopharmacology
Cognitive and affectivebasis of behavior including learning, memory perception, cognition, thinking,motivation, and emotion
Social basis of behavior including social,cultural, ethnic and group processes, sex roles, organization, and systemstheory
Individual differencesincluding personality theory, human development, abnormal psychology, psychopathology,and psychology of the handicapped
Other
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If "Other" Subject Area, describe below
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Instructor(s)Complete as needed. .
Instructor Name
Instructor 1 Qualifications (attach resume at end of application)
Instructor Name (2)
Instructor 2 Qualifications (attach resume at end of application)
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Instructor(s)Complete as needed. .
Instructor Name (3)
Instructor 3 Qualifications (attach resume at end of application)
Instructor Name (4)
Instructor 4 Qualifications (attach resume at end of application)
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Instructor resume(s).Attach resume(s) here
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Max. file size: 10.6MB
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Course Content Form

Complete the next five pages regarding course content. If additional space is needed for course content, download the CE Application and Course Content Form and attach the Course Content form to this application.
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1) Goal(s) / Purpose
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2) Behavioral Objectives
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3) Content (Brief Outline)
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4) Method of Presentation
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5) Evaluation Process
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Checklist of Documents to be Attached

The following documents should be attached, as available and applicable, on the following page:

Course Content Form

Course Evaluation

Brochure

Certificate of Completion
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Checklist - Document UploadAttach, as applicable, Course Content Form(s), Course Evaluation Form, Brochure (if available and applicable, Certificate of Completion
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Submission of ProposalThe signature below acknowledges that all information submitted is correct and grants permission to the Nevada Board of Psychological Examiners to independently verify this information as a condition for acceptance.
Clear
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APPLICATION FEE:

The application fee is $30.00. A service charge $1.17 will be added to cover the administrative costs assessed by PayPal. If you would prefer to pay via check or money order, mail the application and fee to: Nevada Board of Psychological Examiners, 3080 South Durango Drive, Suite 102, Las Vegas, Nevada 89117.
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Application for Approval of Continuing Education Training Program

Course Content Form

Checklist of Documents to be Attached