New YorkState Office of Alcoholism and Substance Abuse Services
Education and Training Provider Certification Application
PART E – CASAC 60-HOUR PROBLEM GAMBLING CORE CURRICULUM - - TREATMENT TRACK
(please type all information)
EDUCATION AND TRAINING PROVIDER:CASAC 60-HOUR PROBLEM GAMBLING CORE CURRICULUM - - TREATMENT TRACK PROGRAM INFORMATION
SECTION I – PROBLEM GAMBLING KNOWLEDGE AND EDUCATION (15 CLOCK HOURS)
TITLE OF COURSE/TRAINING / NUMBER OF CLOCK HOURS
PREVIOUSLY APPROVED / PENDING APPROVAL / ATTACHED FOR REVIEW AND APPROVAL
TOTALS / COLUMN TOTAL / COLUMN TOTAL / COLUMN TOTAL
INFORMATION ON NEXT PAGE MUST BE COMPLETED
PDS – 17.6 (06/08)
New YorkState Office of Alcoholism and Substance Abuse Services
Education and Training Provider Certification Application
PART E – CASAC 60-HOUR PROBLEM GAMBLING CORE CURRICULUM - - TREATMENT TRACK
(please type all information)
EDUCATION AND TRAINING PROVIDER:CASAC 60-HOUR PROBLEM GAMBLING CORE CURRICULUM - - TREATMENT TRACK PROGRAM INFORMATION
SECTION II – SKILLS FOR SCREENING, ASSESSMENT AND DIAGNOSIS (15 CLOCK HOURS)
TITLE OF COURSE/TRAINING / NUMBER OF CLOCK HOURS
PREVIOUSLY APPROVED / PENDING APPROVAL / ATTACHED FOR REVIEW AND APPROVAL
TOTALS / COLUMN TOTAL / COLUMN TOTAL / COLUMN TOTAL
INFORMATION ON NEXT PAGE MUST BE COMPLETED
PDS – 17.6 (06/08)
New YorkState Office of Alcoholism and Substance Abuse Services
Education and Training Provider Certification Application
PART E – CASAC 60-HOUR PROBLEM GAMBLING CORE CURRICULUM - - TREATMENT TRACK
(please type all information)
EDUCATION AND TRAINING PROVIDER:CASAC 60-HOUR PROBLEM GAMBLING CORE CURRICULUM - - TREATMENT TRACK PROGRAM INFORMATION
SECTION III – SPECIALIZED CLINICAL TREATMENT, TREATMENT PLANNING AND CASE MANAGEMENT (20 CLOCK HOURS)
TITLE OF COURSE/TRAINING / NUMBER OF CLOCK HOURS
PREVIOUSLY APPROVED / PENDING APPROVAL / ATTACHED FOR REVIEW AND APPROVAL
TOTALS / COLUMN TOTAL / COLUMN TOTAL / COLUMN TOTAL
INFORMATION ON NEXT PAGE MUST BE COMPLETED
New York State Office of Alcoholism and Substance Abuse Services
Education and Training Provider Certification Application
PART E – CASAC 60-HOUR PROBLEM GAMBLING CORE CURRICULUM - - TREATMENT TRACK
(please type all information)
EDUCATION AND TRAINING PROVIDER:CASAC 60-HOUR PROBLEM GAMBLING CORE CURRICULUM - - TREATMENT TRACK PROGRAM INFORMATION
SECTION IV – RELAPSE PREVENTION AND DISCHARGE PLANNING (10 CLOCK HOURS)
TITLE OF COURSE/TRAINING / NUMBER OF CLOCK HOURS
PREVIOUSLY APPROVED / PENDING APPROVAL / ATTACHED FOR REVIEW AND APPROVAL
TOTALS / COLUMN TOTAL / COLUMN TOTAL / COLUMN TOTAL
PDS – 17.6 (06/08)