ASVCP CPD Form

Continuing Professional Development Form

APSAD and its Smoking and Vaping Cessation Professionals Special Interest Group Continuing Professional Development requirements aim to promote the maintenance and improvement of quality Nicotine Treatment Specialist clinical services, research, and policy offered by its members in a manner that demonstrates the accountability of members to their clients, their professional colleagues, the community, and to themselves.
- APSAD Nicotine Treatment Specialist Credentialled members must earn a minimum of 10 CPD points annually and remain a financial member of APSAD to renew their ASVCP Nicotine Treatment Specialist Credential.
- Points can be earned between 1^st July and 30^th June each year.
Download and complete the CPD Activity Table before you complete this form.

Upload your completed CPD Activity Table before submitting your completed form.
Date*

DayMonthYear
Name*

PrefixFirst NameMiddle NameLast NameSuffix
Email*

Confirmation Emailconfirm your email address
Phone Number*

Country CodeArea CodePhone Number
Current Employer*
Your place of employment
Current Position*
Current position held
Occupation*
Select one of the following options:*

I seek to renew my ASVCP NTS credential for the new membership year.I am applying for the ASVCP NTS credential and am completing this form to support my application.
Applicant's Declaration*

I confirm I am not working or affiliated with any tobacco or vaping organisations, or their subsidiaries AND I hereby declare the information in this form is true and accurate.
If you are applying for an Smoking and Vaping Cessation Professionals Nicotine Treatment Specialist credential, please submit this form together with your Nicotine Treatment Specialist application.
Review your listing on the Nicotine Treatment Finder and indicate below any details that need to be updated using the information provided in this form. (tick all that apply)*

EmailPhoneWebsiteAddress
Upload any supporting documents and/or your completed CPD Activity table

Your application will not be assessed if the CPD Activity table or required documentation is not included with your submission.
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Continuing Professional Development Form