Nicotine Treatment Specialist Credential Application

Nicotine Treatment Specialist Credential Application

APSAD Smoking & Vaping Cessation Professionals Special Interest Group
INFORMATION & PROFESSIONAL EXPERIENCE
Before completing your credentialling application, please ensure you read the Core Competencies for Nicotine Treatment Specialists.

APSAD does not advise on professional indemnity insurance and has no responsibility for any additional insurance requirements or costs. Applicants should seek separate advice regarding any public liability and professional indemnity insurance requirements, which may be associated with the successful award of a credential.
Name*

PrefixFirst NameMiddle NameLast NameSuffix
Email*
email address
Phone Number*

Area CodePhone Number
Workplace*
Your place of employment
Current Position*
Current position held
Enter the name/s of other professional bodies you are a member of
Skip to next question if none.
How many nicotine treatment related clinical hours do you currently work per month? *
A minimum of 16 hours per month is required. Nicotine cessation related work can include research, education, training, or treatment
Provide a brief summary of your nicotine and/or smoking cessation work.*
Detail the work you do around nicotine and/or smoking cessation
List the details for any nicotine and/or smoking cessation training courses and activities you have completed in the past 12 months*
If it has been more than 12 months since your last course and/or training, you must complete the APSAD Smoking and Vaping Cessation Professionals CPD activity table and submit this with your application, you can upload the completed table in the evidence section.
If it has been more than 12 months since your last course and/or training, you must complete the APSAD Smoking and Vaping Cessation Professionals CPD activity table and submit this with your application, you can upload the completed table in the evidence section below.
Provide evidence for any nicotine and/or smoking cessation training courses and activities you have completed*

Upload your file/certificates.
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The Smoking & Vaping Cessation Special Interest Group recognises the RACGP Smoking Cessation Guidelines for Australian General Practice.
I practice evidence-based nicotine and/or smoking cessation interventions as recognised by the APSAD Smoking & Vaping Cessation Special Interest Group.*

I Agree
Insurance Disclaimer*

I understand APSAD does not advise on professional indemnity insurance and has no responsibility for any additional insurance requirements or costs and I should seek separate advice regarding any public liability and professional indemnity insurance requirements, which may be associated with the successful award of a credential
REFEREE INFORMATION

Provide the details for one referee. Your nominated referee will be contacted by an APSAD representative and asked to comment on your professional competency and experience in nicotine and/or smoking cessation treatment. It is desirable that the referee currently works in the profession in either the clinical or research area for nicotine and/or smoking cessation.
Referee's Name*

PrefixFirst NameLast Name
Email*
Referee's email
Referee's Phone *

Area CodePhone Number
Referee's Workplace*
Referee's Current Position*

Nicotine Treatment Specialist Credential Application

INFORMATION & PROFESSIONAL EXPERIENCE

REFEREE INFORMATION

Nicotine Treatment Specialist Finder Contact Details

DECLARATION