Council for Tobacco Treatment Training Programs

[Program Name]

Five-Year Program Re-accreditation Application

Designated Contact Person
Name:
Title:
Address:
Email:
Phone:
Fax:
Designated Secondary Contact Person
Name:
Title:
Email:
Phone:

Certification Date from [Current Accreditation Date] to [Current Expiration Date]

Application Due [3 months prior to expiration]

Program Information
Name of Sponsoring Agency/Organization
(if applicable):
Mailing Address:
Website (if applicable):

TABLE OF CONTENTS

Re-accreditation Instructions…………………………………………………………………… 3

Required Materials……………………………………………………………….……...……… 4

Statement of Understanding………………………………………………………...…………...9

INSTRUCTIONS

Please review the entire re-accreditation application. If there is a section of the application that is unclear, please email for clarification.

  • All application materials must be submitted electronically in English as a PDF portfolio.
  • Submissions must contain the complete application and all required attachments.
  • The program must continue to effectively addressall accreditation standards.
  • Electronic documents should be sent to .
  • The program must submit the $1,000accreditation fee payable to “ATTUD”. Payments should be mailed to:

Board of Councilors of the Council for Tobacco Treatment Training Programs, 2424 American Lane, Madison, WI 53704

Summary of Program Growth

  1. Summarize changes to the program’s purpose, structure, activities, mission, and/or goals over the last five years.
  1. Describe how these changes impacted your program.
  1. Summarize changes to key staff members overseeing the program, faculty,and roles of current staff members and/or faculty over the last five years.

*Include a CV or resume for new faculty or new key staff members.

  1. Describe how these changes impacted your training program.
  1. Summarize changes in the curriculum over the last five years.
  1. Describe how these changes impacted your training program.
  1. Summarize changes to the grievance procedure, refund, and cancellation policies over the last five years.
  1. Summarize changes to the program’s capability to provide services, including any changes in the population the program serves over the last five years.
  1. Describe how these changes impacted your training program.
  1. Summarize changes to the program’s marketingover the last five years.
  1. Describe how these changes impacted your training program.
  1. Summarize changes to the program assessment and evaluation over the last five years.
  1. Describe how these changes impacted your training program.
  1. Summarize participant evaluations over the last five years. Include a sample of the evaluation(s) provided to participants.
  1. Describe how the evaluations over the last five years have impacted your training program.
  1. Describe at least onefive-year goal for your program. Goals should be specific, measurable, attainable, realistic, timely, and relate to challenges and opportunities encountered by the program. A goal is likely to include activities that the leadership would like the program to do differently.

Potential five-year goals might focus on:

  • The number of individuals trained annually
  • The development of curricular innovations
  • The development of different training modalities or delivery systems
  • The development of new outreach opportunities
  • Technological enhancements
  • Attracting new training audiences
  • Other relevant changes that will enhance theprogram

Example goals:

  • We will increase the number of individuals trained annually by 3% per year
  • Wewill produce three continuing education webinars annually.
  • We will deliver three components of our training online.
  1. Describe your rationale for the goal.

Describe the reasons for choosing the selected program goals.

  1. Assessing and evaluating goals.

Explain the steps you plan to take to assess progress on the selected goal(s). If there will be an effect on the program trainees, how will you evaluate this effect?

  1. Objectives are steps needed to achieve the selected goal(s). Similar to goals, objectives are specific, concrete, measurable, and have a definitive timeframe. Describe the objectivesneeded for the program to meet the selected five-year goal(s). Use the format below for each objectivethat you have.

Goal:

Objective One:

Activities / Timeline / Collaboration / Date Completed

ObjectiveTwo:

Activities / Timeline / Collaboration / Date Completed

Tobacco Treatment Specialist Training Program Re-accreditation

STATEMENT OF UNDERSTANDING

As the Designated Contacts for [Program Name], we acknowledge that all the information in this application is correct and accurate.In addition, we understand that we may be required to furnishadditional information to the Board of Councilors in order for them to determine whether our program complies with accreditation requirements.



Signature of DesignatedContactPerson SignatureofSecondaryContactPerson



DateSigned DateSigned

1

Updated12/14/18