CEB — One Year Renewal

Application for Recertification

One (1) Years — AADC / CCDP-D
Dear AADC or CCDP-D holders, please refer to the LASACT website for additional information on your AADC or CCDP-D. If you plan to let your credential lapse, please alert the LASACT office so that our files and database can be adjusted.

When renewing your AADC or CCDP-D for the one-year period, please pay particular attention to the information about the continuing education hours that are required. The hours for your CCDP-D must be in integrated services, dual diagnosis, and/or co-occurring disorders. Nothing else will be accepted. For your AADC renewal, the only needed documentation is your practice credential card, which acknowledges that you have the hours necessary to renew.

A generic IC&RC certificate is included in your renewal packet. Holding this certificate allows you to reciprocity your credential to another state or country that IC&RC recognizes. Also, you have the option of ordering an official ICAADC international certificate for a fee of $25.00 for each certificate requested. This certificate displays your official certification number that IC&RC issues, whereas the generic certificate does not have this displayed. A form is attached should you want to order an Official ICAADC Certificate.
SECTION 1: Applicant Information
Name to appear on certificate(s):
Email Address (Required)
example@example.com
Confirm Email Address (Required)
example@example.com
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number (if applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Place of Employment
Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Required Enclosures: Please check each item to verify that a copy is attached

Copy of current Right to Practice Credentialing Card or other masters level credentialing card showing an approximate expiration date of six weeks prior to your AADC, CCDP, CCDP-D, or CCJP renewal date. Your AADC, CCDP, CCDP-D, or CCJP renewal cannot be processed until we receive a copy of your card verifying that you hold a current and valid right to practice credential.
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Recertification Payment Options

Convenience fees will be assessed on all credit/debit card payments.
Credentials applying to be recertified:
Select all that apply to your renewal:
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One Credential Current LASACT Member Rate
Recertification fees are $60 for LASACT members. Price includes: $60 recertification fee + $2.34 transaction fee for all credit card payments.

$62.34 Quantity



One Credential Non-LASACT Member Rate
Recertification fees are $90 for non-LASACT members. Price includes: $90 recertification fee + $3.51 transaction fee for all credit card payments.

$93.51 Quantity
Item subtotal:$0.00



Late Fee
Late fee for each certificate renewal submitted after the expiration date. Price includes: $50 late fee + $1.95 transaction fee for all credit card payments.

$51.95 Quantity



International Certificate
Charge for each Official International. Price includes: $25 international certificate + $0.97 transaction fee for all credit card payments.

$25.97 Quantity



Total

$0.00
Summary of Continuing Education

Continuing Education Requirement: A total of 20 hours in integrated services, co-occurring disorders, and/or dual diagnosis is required.
Instructions:
- Enter only one educational event per row;
- Provide the information requested in each column for each educational event;
- Number of hours must total a minimum of 20 for the certification period;
- Attach a copy of a certificate for each educational event listed. Certificates must show the provider, date(s), title of event, speaker/presenter, number of contact hours completed, and your name. Certificates without this information will be rejected;
- If college or university credit was given, hours are detemined at the rate of 15 clock hours per semester credit hour;
- Hours recieved up to 90 days preceding this cycle can used if they were not used in a previous renewal cylce;

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Certificate Upload

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Signature belows denotes that the applicant:

1. Is currently active in the field of alcohol and substance abuse;

2. Is free of any ethical or malpractice violation;

3. Accepts all of the principles of the Code of Ethics and Disciplinary procedure;

4. Applicant understands that the AADC/CCPD-D certificate is not a substitute or a replacement for the Social Worker credential and therfore is NOT a license with which to practice substance abuse counseling.
Signature
Should be Empty:

Application for Recertification

SECTION 1: Applicant Information

Recertification Payment Options

Select all that apply to your renewal:

Summary of Continuing Education