WEST VIRGINIA BOARD OF PHYSICAL THERAPY

101 Dee Drive

Charleston, West Virginia 25311

Telephone: (304) 558-0367 Fax: (304) 558-0369

INSTRUCTIONS FOR CE FORM B (RE-APPROVAL)

APPLICATION FOR CONTINUNING EDUCATION REVIEW

Do not use CE FORM B for a new course. Use for courses approved last year.

  • CE applications are for use by CE providers only

Form B is not to be used by WV PT or PTA, unless they are the CE Coordinator for their facility.

  • Course requirements

Course must have the same title, objectives, an presenter/s. You cannot skip a year to receive a re-approval of a course.

  • Conferences or Seminars (annual or not) – Do not qualify for this form

These typically have varied topics, with different objectives, and different presenters that when it was originally given an approval number by the Board. Conferences or seminars do not qualify as a “once-approved” course (use CE form A).

  • Completed CE Form B

CE Form B must be completed in its entirety. Use a separate form for each course.

  • Copy of Approval Letter
  • Send a copy of the approval letter from last year with completed Form B. If no changes in course, do not send backup material other than priorapproval letter.
  • Do not staple any documents.
  • Fees are Non-Refundable

There is a $50.00 fee per course that is submitted. If submitting more than one course, fees may be combined into one

Business Check, Money Order or Cashier’s Check. We do not accept personal checks.

  • Time Frames

All materials should be submitted to this Board at least eight weeks prior to the date the course is being offered or the date

an answer is needed from this Board . Processing time may be extended in October, November, December, and January

because of license renewal season. Incomplete applications or incorrect fee amounts may be returned.

  • Approved Courses

An approval number will be assigned and also an approval letter will be sent via mail. The number of contact hours will remain

the same as last year.

  • Website

All approved courses will be listed on our website. The Board is not responsible for courses not being posted prior to course

date(s).

  • Include the Following Statement on Course Materials:

Approval of this course does not necessarily imply that the WV Board of Physical Therapy supports the views of the

presenter or sponsor.”

  • Required Documents for Attendees:

Attendees should receive a copy of brochures, handouts, payment receipt, and a Certificate. This Certificate should state the

person’s name, name of the course, date of the course, number of hours earned, WV Approval number; and a signature of

your Company’s representative.

  • PT/PTA Listing Price Quote:

You may email the board with your specific request giving us your name, company name, email address, telephone

and fax. Since our database information is updated daily, we will email you a price quote with an effective date. Listings

are available in Excel or PDF format. If you have submitted a CE course to this board for review, and are interested in a

licensee listing for that course, we suggest for you to wait on the CE Committee's review prior to purchasing the listing

as fees are non-refundable even if the course is NOT approved.

REAPPROVAL (FORM B)

APPLICATION FOR CONTINUING EDUCATION REVIEW

  • Fee for CE course re-approval is $50.00 per course. We accept payment via money order, cashier’s check, orbusiness check; we do not accept personal checks.
  • If no changes in course, do not send backup material other than prior approval letter
  • Do not staple any documents
  • All courses that are approved willbe listed on our website at

SECTION I: Company/Organization Information
Have course title, objectives, or presenter changed since approved in previous year? Yes: No: (If yes, use CE Form A) / Phone:
Company/Organization: / Fax:
Contact Name: / Email:
Mailing Address: / Web:
City: / State: / Zip:
SECTION II: Mail Results to:(Put “Same” if same as above)
Name:
Address:
City: / State: / Zip:
SECTION III:For Website (Put “Same” if same as in section I)
Name: / Phone: / Email:
Company: / Fax: / Website:
SECTION IV: Course Approval (Attach copy of previous year approval letter)
Prior Year Approval Number: / Approval Year Requested:
Course Title:
Live Presentation: / Internet Course:
Home Study Course:
SECTION V: Course Dates & Presenter
If Four or More Course Dates, Put “Various” and Provide a List. Send Presenter bio paragraph; criteria for presenter/s are not acceptable.
Course Date: / Location: / Presenter(s):
Course Date: / Location: / Presenter(s):
Course Date: / Location: / Presenter(s):
Target Audience (Check one): PT’s only / PTA’s only / Both PT/PTA’s
Number of contact hours remains same as approved last year? Yes: No:
Number of contact hours requested:
Registration Required: Yes: No:
SECTION VI:This same course with the same presenter(s) has been approved for the current or previous year for the same number of contact hours by the following organizations, other Physical Therapy Boards, or other Licensing Boards: (Please do not leave blank-if none, enter “none”.)
PT Boards:
Other Boards/Organizations:
SECTIONVII: Signature
Signature: / Date:

CE FORM B – FILL IN 12/11