Please Complete and Email to Marie Grover, Cemanager

Please complete and email to Marie Grover, CEManager

Email:

Phone: 800-800-8126 Ext. 82

iaedp ChapterName:

Title ofPresentation:

Date ofPresentation:

Length ofPresentation:

Number of CE Hours requested
(note 1 hour of presentation time = 1 CE)

Name ofPresenter(s)

(At least one presenter must hold a master’s level degree or higher in a mental health related field)

Fee:$25.00

Payable online (preferred method) by clicking here: iaedp CE purchase form
-OR-
Payable via check to:
International Association for Eating Disorder Professionals
Mailing Address: iaedp, PO Box 1295, Pekin, IL61555-1295

IMPORTANT: Please Send a copy of this form and write chapter name on check.
Example: “San Diego Chapter CE’s”

Please read and sign if the presentation will berecorded.

I understand and give my permission for my workshop to be recorded (audio). These recordingsbecome the sole property of iaedp™. I understand that they may be used for online educational purposes in the future.

I (we) release and authorize International Association of Eating Disorder Association to use the recorded copy of the above stated seminar asdesired.

Chapter Education ChairSignature

Presenter(s)Signature

Presenter(s)Signature

iaedp is accredited to provide CE hours through

NBCC – Provider number 5912

CDR – Provider #IN004

Iaedp Chapter Event Checklist

1.Email Request form along with the following items to Marie Grover ()

•Complete CV or resume for each presenter

•Program overview complete with no less than 3 complete learning objectives

•Copy of any post-test that will be given

•Copy of an e-mail or advertisement with the NBCC /CDR statement and logos

2.Once the materials are reviewed an e-mail approval will be given

3.Pay the $25 fee online or via check

•For online payments click here

•If mailing a check please be sure to include a copy of the CE request form with your payment. Also note on the check the chapter name and CE Event.

4.If additional information is needed based on the presentation content it will be requested.
(See Guidelines # 4 and#5.)

5.Within 30 days after the event email the sign-in sheets indicating who has received a certificate, copies of any post-test and the evaluations to

General Program Requirements

1.Programs must directly relate to one of the following topics

1. Counseling Theory/Practice and the Counseling Relationship.
2. Human Growth and Development.

c.Social and Cultural Foundations

d.Group Dynamics and Counseling

e.Career Development and Counseling

f.Assessment

g.Research and Program Evaluation

h.Counselor Professional Identity and Practice Issues

i.Wellness and Prevention

j.Dietetics

2.At least one presenter must hold a master’s level degree or higher in a mental health field from an accredited institution

1. All programs must be geared toward the master’s level healthpractitioner.
2. Programs based on new or alternative psychotherapeutic theories or methodsmust submit documentation of current or past research supporting the efficacy of the theory or method. If research is not available, the provider must show evidence of acceptance by the professional mental health community such as a publication in professionalliterature.
3. Programs focusing on ethics in mental health practice must include information on the ethical codes NBCC and/or the American Counseling Association.
4. For advertising and program announcement purposes the following terms are acceptable to describe the credit hours being awarded: clock hours; credit hours; CE hours; or, contact hours. The descriptive term CEU cannot be used.

General Program Requirements (Cont.)

7.All advertisements (electronic, flyers, mail etc) sent out regarding the event must clearly convey the following:

a.Program registration requirements

b.Number of CE or NBCC hours offered

c.Program Description and a minimum of 3 learning objectives

d.Presenters and presenter credentials

e.Date/Time/Location

f.RSVP information including Name, Mailing address, Phone Number, e-mail and website

g.The following statement regarding NBCC and the NBCC Logo (provided) must also be on the materials sent out

i.iaedp Foundation has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5912. Programs that do not qualify for NBCC credit are clearly identified. iaepd Foundation is solely responsible for all aspects of the program

h.The following statement regarding CDR and the CDR logo (provided) must also be on the materials sent out

i.iaedp is a Continuing Professional Education Accredited Provider, under Provider #IN004 recognized by the Commission of Dietetic Registration.

8.All participants must sign in and sign out in order to receive CEs.

a.In order to receive CEs attendees must be in session for the total length of program. A five minute grace period at beginning and end of session will be allowed. No partial CEs will begiven. 1 hour face (voice) time equals 1 CE clockhour.

b.Please use the new sign in sheet provided

9.All participants must fill out an evaluation (provided)in order to receive CEs

10.Eligible participants will be issued a certificate of attendance (provided)

11.All potential conflicts of interest, including commercial bias must be disclosed (form provided)

International Association of Eating Disorders Professionals * PO Box 1295, Pekin, IL 61555-1295

T: (800-800-8126) F: (800) 800-8126 *

Revised 04/2016 LMG