NASP Approved Provider Renewal

Instructions: Please complete the attached form to renew your NASP Approved Provider status. You may complete the form in one sitting, or you can save the form to complete at a later date. If you want to partially complete the application and save, you must create a free Jotform account to do so.

Payment can be made online via credit card, debit card, Paypal, or Venmo. For instructions to pay by check, see the "Payment" section, below.

If you have any inquiries, please contact aps@naspweb.org.

Organization Information*

Organization NameCPD Director

Email of CPD Director*

example@example.com

Yes

I have read the APS policy manual

Provide any other relevant contacts within your organization, including name, title, and email

NASP Approved Provider #

Initial Approval Date

Date

Most Recent Renewal Date (If this is your first renewal, re-enter your initial approval date)

Date

File Upload: Please upload the CV or Resume of the individual who oversees the school psychology content of your CPD programming. This may be your CPD Director or another individual with a school psychology background.*

Please list the continuing professional development activities offered by your organization within the last 12 months to school psychologists, along with the NASP domain(s) corresponding to program content (list domain numbers). If you have more than 10, you may upload a separate file immediately below. Simply indicate "file attached" in the fields below.*

Rows	Program Title Offered	# of Attendees	Domains(s)
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)

If you have more than 10 activities to report, you may provide that in a separate file and attach that here using the same structure as the grid directly above.

File Upload: For TWO of the professional development activities you listed in Attachment A upload:- Program announcements and registration forms and program brochure- CV or profile sheet for the presenters- Evaluation materials (i.e. blank evaluation form, summary of ratings)- State which NASP Professional Domains were addressed in each session*

In PersonVirtual (synchronous/live)Virtual (asynchronous/recorded/on demand)

IN-PERSON: If you will provide In PERSON trainings, please 1) describe the facilities in which your organization conducts its in-person continuing education activities. 2) Describe accommodations made for program participants who have physical disabilities or sensory impairments.

VIRTUAL (SYNCHRONOUS/LIVE): 1) Provide a detailed description of the strategies that will be employed to ensure participant engagement. Any technology used for virtual events must effectively track attendance, much like the provider would do at a live event. For example, some platforms provide integrated participant tracking or intermittent pop-ups, though use of this software may require some added financial burden to the provider. Other strategies could include presenting codes using letters, numbers, or pictures at random times during the presentation, and requiring the participants to enter the complete code to “unlock” access to or as a separate question on the evaluation form. Requiring participants to keep their cameras on and using proctors to monitor attendance, while labor intensive, may be feasible if the number of participants is small enough to be manageable. A posttest is not required for live attendees as long as they have the ability to interact and ask questions of the presenter. 2) Describe accommodations made for program participants who have physical disabilities or sensory impairments.

VIRTUAL (ASYNCHRONOUS/RECORDED/ON-DEMAND): 1)Provide a detailed description of the strategies that will be employed to ensure participant engagement. Any technology used for virtual events must effectively track attendance, much like the provider would do at a live event. For example, some platforms provide integrated participant tracking or intermittent pop-ups, though use of this software may require some added financial burden to the provider. Other examples include requiring completion of content questions at different points in a presentation before the participant can proceed to the next section. Other strategies could include presenting codes using letters, numbers, or pictures at random times during the presentation, and requiring the participants to enter the complete code to “unlock” access to or as a separate question on the evaluation form. If the asynchronous presentation is using a recording of a synchronous/live presentation, the codes should be different than the synchronous presentation codes. Any content offered on demand must have a posttest to assess learning in order to provide NASP-approved CPD. 2) Describe accommodations made for program participants who have physical disabilities or sensory impairments.

If other changes have been made to your programming since your last submission or if the committee requested that you respond to recommendations on your last submission, please describe here.

Please verify that you are human*

Certification (certify the information is complete and accurate)

Everything that I have stated in this application is correct to the best of my knowledge.

Name and Title

Applicant Signature

Date

Inquiries: aps@naspweb.org

Pay Online (see below)Pay by Check (please mail your check for $150 to NASP, 4340 East West Highway, Suite 402, Bethesda, MD 20814, Attn: Emilie Ney and write on the "notes" line of the check "APS" and the name of your organization)

Renewal fee of $150

USD

What is the name displayed on the credit card?*

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

National Association of School Psychologists