Adobe FormsCentral

COLORADO STATE CERTIFICATION or LICENSURE APPLICATION for Colorado Testing Requirements for CAT, CAS and LAC

SELECT EXAM and TESTING DATE

SELECT EXAMINATION: select from the member or non-member choices in drop down menu:*

Please choose Live Testing OR Online Proctoring:

CANDIDATE INFORMATION

First Name:*

Middle Name:

Last Name:*

Legal name for Certificate:*

CONTACT INFORMATION

Email Address: Please enter a valid email address.

Your Email Address:*

Confirm your Email Address:*

Home or Preferred Mailing Address:Eligibility Notices and Score Reports will be mailed to this address.

Street Address:*

Apartment or Suite:

City:*

State/Province:*

Zip or Postal Code:*

Country:*

Work/Business Address (Optional):

Organization:*

Title/Position:*

Street Address:

City:

State/Province:

Zip or Postal Code:

Country:

Phone Numbers:

Work Phone:*

Home Phone:*

Cell Phone:*

Phone Preference:

Please select your preferred phone for communications.*

WorkHome/Cell

Address Preference:

Please select your preferred address for communications. Pass/Fail notification of your Exam will be sent to home address only.*

HomeWork/Business

Request for Special Needs Accommodations or Testing Center Location:

Are you requesting special testing accommodations and have a disability covered by the Americans with Disabilities Act? Or specific testing center accommodation?*

YesNo

If yes, please explain your request:

STATE CREDENTIAL - RELEASE AUTHORIZATION

DO NOT COMPLETE THIS APPLICATION if you already hold a state credential AND are applying for a national credential through NCC-AP.

If you have questions about this or need clarification,

please call CAAP at 303-637-2660 to speak to the testing coordinator.

Are you applying to take this exam for Colorado state credentialing purposes?*

YESNo

If "NO", enter the state. If you have questions, please contact CAAP at 303. 637. 2660.

State:

I hereby authorize the National Certification Commission for Addiction Professionals (NCC-AP) to release the results of my Certification Examination for Addiction Counselors to the state indicated. I understand that these test results will be used only for state certification at this time.

Please type your full LEGAL NAME to sign for Release Authorization: *

IN ORDER TO SIT FOR THE MAC EXAM: You have to have your Master"s degree awarded prior to sitting for the exam, per Colorado state law.

If you are applying to take the MAC, what was your Master's or Doctorate degree in?*

EXAMINATION AND CERTIFICATION INFORMATION

Please confirm which Exam you are applying for:

Which exam option:*

Live - testing site optionOnline - computerized testing option - proctored exam

By checking this box, I confirm that I understand that there are NO REFUNDS of money paid and that changes to testing date/site/option must be made 5 days in advance of scheduled testing.*

true

By checking this box, I confirm that I understand the equipment- and space-specific requirements associated with online proctored exams. There are NO REFUNDS of money paid for not taking the proctored exam due to scheduling, space, equipment, etc. Changes to dates or type of exam must be made 5 days in advance of scheduled testing.*

Yes, I confirm my understanding.

Choice of Examination Language:*

EnglishSpanish

Have you taken this examination before and not passed it?*

NoYes

If you have taken this exam before and not passed it, please tell us what year and how many times?

Eligibility and Background Information

In which of the following do you spend at least 10 hours per week on (check all that apply on menu) :*

Percent of working time currently spend in alcoholism and drug abuse counseling (use drop down menu)?*

Treatment or Modality you provide (use drop down menu):*

Professional Background (use drop down menu):*

Years of experience in Alcoholism and Addiction Counseling (please use drop down menu):

Highest Academic Level Attained: please use drop down menu:*

Which field do you currently hold your main license or certification:*

Are you a member of NAADAC?*

YesNo

Comments for Test Coordinator:

READ CAREFULLY

CANDIDATE STATEMENT AND SIGNATURE

Testing is available on demand. You are able to sign up for the date and time that is most convenient for you, depending on the testing center’s availability. You will be able to see availability at testing centers in your area online after you register for your examination - you will receive links and information to set up your test date and location from CAAP within 7 days of registering.
You can reschedule via the testing website at any time before your examination. If you attempt to reschedule within 72 hours of your test appointment, you will pay a $95 reseating fee. This fee is charged by the testing center itself, and NCC AP and CAAP are unable to waive it.
You can cancel your examination up to 72 hours before the testing appointment. Refunds are not issued if the exam is cancelled with 72 hours of the scheduled date.
If you miss your testing window, refunds are not issued. The testing contractor, Kryterion, does not reimburse CAAP or NAADAC for tests not taken, so we are unable to issue a refund.
If you failed an examination required by OBH and DORA, you will need to contact CAAP to register again for the exam. The cost for re-testing is the same. You can take an exam up to three times in a calendar year. If you fail the exam three times in a calendar year, NAADAC requires that you wait until the next calendar year to try again. During that time, you can study again and look for new resources to help you, such as the new and revised Basics of Addiction Counseling Study Guides.
NAADAC/NCC AP sends an official score notice with your passing score to DORA. NAADAC/NCC AP sends score reports to DORA, by e-mail, every two weeks. You will receive an e-mail with your unofficial scores when you finish the examination.
NAADAC/NCC AP provides an online practice test. You can purchase the practice test for $35. The practice test includes 70 questions that have previously been used on NCAC I, NCAC II, or MAC examinations. The practice test can give you a good sense of the types of questions you will see, and what the examinations will look like. When you submit the practice test, you will see test results of "pass" or "fail" immediately. However, the results will not show you which questions you got wrong. The practice test is designed to give you an overview of the type of questions and the way they are worded, and NCC AP believes that focusing on the few questions you got wrong is counterproductive. The link to this practice test can be found on CAAP's testing page or at: http://naadac.impakadvance.com/members_online/members/viewitem.asp?item=PRACTEST&catalog=NCC&pn=1&af=NAAD.
Test questions reflect the DSM-5.

I understand that my eligibility for the exam I am registering for will be verified by the Colorado certifying bodies (DORA and/or OBH) and CAAP. Please make sure you are eligible for the exam you wish to take. Specifically, you must have a behavioral health degree conferred to you prior to sitting for the MAC exam. We do reach out to people on a regular basis to make sure they have the degree required by OBH/DORA and to make sure their degree has been conferred prior to testing (per Colorado state law).

In order for your application to be accepted by CAAP and NAADAC - you must check the following box:

By checking this box, I certify that I have read all of the statements above and have the appropriate education for the test I am applying for. I also understand the cancellation and refunds policy as presented above.*

true

Please type your full LEGAL NAME to sign this application.*

PAYMENT AND SUBMISSION INFORMATION ON NEXT PAGE

PAYMENT AND SUBMISSION INFORMATION

PAYMENT MUST BE SUBMITTED to start processing your application.If the bank is unable to process the payment, you will be prevented from testing. A. In order to sit for the MAC Exam - you must already have your Master's degree. B. Before submitting this application, please check that the information you have submitted on this form is accurate and complete. C. Before submitting this application, please verify that you have registered for the correct level of examination (contact CAAP at 303. 637. 2660 if you are not sure).

1. You are advised to save and/or print the completed application for your records. You should receive a completed application from CAAP, upon submission of this form online. Payment must be received in order for us to process your application. 2. Credit card payments process much faster than checks. To use any credit card, the "Proceed to Checkout" button is at the bottom left of this application. Credit card payments are processed by PayPal. If you do not have a PayPal account, sign in as guest user on the next page. Once you pay, and hit pay or submit - your application is automatically submitted with the payment. You are done at this point and can close any open pages. 3. If you prefer to pay by check and not by credit card - you will need to print this completed application and mail it to: CAAP, CAC Testing Coordinator, PO Box 9384, Denver, Colorado 80209. The check must be attached to the paper application; please use the online form and print it as it is easier for us to read and verify. Returned checks will incur an additional $50.00 fee for bank and CAAP processing charges.

Direct your questions to 303. 637.2660 BEFORE submitting your application.

Test Selected for Purchase: Select only One Exam*

NCAC I: Nonmember$215.00

NCAC I: NAADAC Member$200.00

NCAC II: NONMEMBER$225.00

NCAC II: NAADAC MEMBER$200.00

MAC: NONMEMBER$235.00

MAC: NAADAC MEMBER$200.00

Total $0.00