Annual Chapter Report 2015

Please complete this form and send it to: Krista Argiropolis, Administrative Coordinator, () by January 1, 2016.

If you have any questions or need more time, please let us know.

1. CONTACT INFORMATION
Chapter Name:
Chapter Convener:
Convener’s Phone or Mobile Phone: / Email:
2. CERTIFICATION
Please list the following:
Name of person(s) to be recertified and certification category:
Name of person(s) newly certified (approved for certification at the 2015 Plenary) and certified category:
Name of certification candidates who will be going before a Review Panel, under the new Certification Process (August 1, 2015) this upcoming year:
If your Chapter does not have critical mass, which Chapter(s) assisted your Chapter with the Certification process:
Name of person(s) as “members” (no certification but active in the Chapter):
Are there members of you Chapter who have been absent from meetings over an extended period of time, and if so, how are you justifying their recertification?
Conveners are to review the Directory,at cpsp.org, for listings of your Chapter members, their certification and contact information. This listing is an official document and accuracy is of utmost importance for your members’ certification.Send updates or corrections to .
3. ACCREDITATION
List training centers functioning under the authority of your Chapter, with the name(s) of the training supervisors or SIT’s, and date of last accreditation site visit, if applicable.
4. CHAPTER CONSULTATION
Has the Chapter made use of consultation in the past year? Yes No
If not, why?
Who were the consultant(s)?
Would the Chapter be willing to share the nature of the consult?
5. DISCIPLINE
Disciplinary action taken by Chapter relevant to members and/or training centers: Yes No
If yes, please explain:
6. CHAPTER MEETINGS AND MEMBER INTERACTION
Describe the chapter meeting structure and other forms of member interaction.
A. Number of face-to-face meetings during year:
Duration of the meetings (hours, approximate):
Time of the day of meetings (morning, evening, etc.):
Typical time formats of the meetings (Agendas):
B. Number of conference calls/Skype or Zoom sessions:
Duration of the sessions (hours):
Time of the day of sessions (morning, evening, etc.):
Typical time formats (agendas) of the sessions:
C. Other forms of interaction and cooperation:
  1. What were the accomplishments of the chapter for the improvement of chapter life during the year?
We encourage all members to be in contact with Perry Miller, Chapter Life Chair, at .
7. CHAPTER’S CONTINUING EDUCATION/PROFESSIONAL DEVELOPMENT
Describe the chapter’s continuing education and professional development plan and what actually was accomplished, as well as plans for the upcoming year:
8. CHAPTER MEMBERS PARTICIPATION IN CPSP-WIDE ACTIVITIES
Describe the chapter members’ participation in CPSP-wide activities. A short paragraph or two describing your chapter’s practices and experiences for each heading listed below will be sufficient.
  1. Plenary attendance (number of members):
  2. Participation in CPSP committees (Finance, Communication, Certification, etc.):
  3. Attendance at inter-chapter/NCTS/regional activities:

Please remember to save this form to your computer and to email your completed form to .

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