Initial and Recertification Application for Emeritus Status Certification

West Virginia Certification Board for Addiction and Prevention

Initial, Recertification, or Active Status Reactivation Application for Emeritus Status Certification
West Virginia Certification Board for Addiction and Prevention Professionals
436 12th Street Suite C Dunbar, WV 25064
Phone 304-768-2942
Email: wvcbapp@wvcbapp.org

The Emeritus Status Certification is a specialized category for an active Advanced Alcohol and Drug Counselor (AADC); Alcohol and Drug Counselor (ADC); Clinical Supervisor (CS); Certified Criminal Justice Professional (CCJP) and Preventions Specialists (PS); Peer Recovery Support Specalist (PRSS-MH/SUD) who hold a valid certification under the WV Certification Board for Addiction and Prevention Professionals.

If approved, transfer from Active to Emeritus status typically applies ONLY to the specific active WVCBAPP credential(s) that the eligible candidate specifically wishes to transfer into Emeritus status. HOWEVER, a credential holder who transfers a credential into Emeritus status MAY NOT maintain any credentials that it serves as a prerequisite for in active status. Those additional credentials would automatically also transfer to Emeritus status as of the approval date of the application to transfer the prerequisite credential into Emeritus status.

The Emeritus status DOES NOT currently reciprocate into any other IC&RC Member Board. Furthermore, those in Emeritus status (at IC&RC’s discretion) may become ineligible to serve either on IC&RC’s Board of Directors, IC&RC committees, or as an IC&RC approved subject matter expert (SME).

Those in Emeritus status who subsequently wish to transfer back into active status for any reason must submit this application in addition to a completed WVCBAPP active status renewal form (as well as meet all renewal requirements) for each WVCBAPP credential they wish to reinstate into active status.

Requirements for Emeritus Status Certification
- Certification in good standing
- Have at least twenty (20) years experience in the addiction field, of which 15 has been as an AADC, ADC, CCJP, CS, PS, or PRSS-MH/SUD
- Have retired from full-time work
- May work part-time, not to exceed twenty (20) hours per week of paid employment.
Recertification for the Emeritus Status Certification
- Apply for recertification every two (2) years affirming they still meet the above criteria;
- Agree to abide by the current addiction code of ethics;
- Pay a recertification fee for AADC, ADC, CCJP, PS, PRSS-MH, PRSS-SUD, CS;
- Does NOT need to meet Continued Education requirements.
Requirements for transfer of credential(s) from Emeritus to Active Status
- Emeritus status must be current and in good standing
- Must furnish proof of having completed all renewal requirements for the applicable credential(s) Active Status PRIOR to submitting transfer application
- May resume full-time employment in the profession upon approval of transfer request
Date*

MonthDayYear
Date
Is this your initial, recertification, or request to return to active status?*

Initial ApplicationRecertification ApplicationReactivation of Active Status from Emeritus
Name*

First NameLast Name
Former Names
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which certification(s) do you hold?*

AADCADCCCJPCSPS IPSIIPRSS-MHPRSS-SUD
Certification(s) Number*
Upload Proof of Current Employment Status*

Cancelof
How will you be paying the assocated fees?*

Via PayPal using this formMail a checkMail a money orderVia PayPal using the WVCBAPP.org website
Payment
prevnext( X )
Emeritus Status OnlyUse this link to pay the Emeritus status fee or mail a check for 75.00 to WVCBAPP. Use the quantity box to pay for more than one credential.
$81.00 Number of Credentials



Emeritus Status + Clinical Supervisor Use this link to pay the combined fee for Emeritus Status and Clinical Supervisor or mail a check to WVCBAPP for $100.00.
$108.00



Late/Rush Processing FeeInclude after 8/30 of your recertification year. This can also be paid on our website or via mail. All payments made via PayPal are charged an 8% processing fee.
$81.00



Total

$0.00
Email or Name Associated with the the PayPal Account
My signature on this form attests that if I am serving IC&RC in any capacity as of the effective date of my transfer into Emeritus status, I will promptly inform the appropriate IC&RC personnel of the effective date of this change to my credential status (if applicable).
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West Virginia Certification Board for Addiction and Prevention