Approved Program Status Application

Program Information


Program Title:
Start Date of Program:	End Date of Program:
Location of Program:
Provider of Program:

Contact Information


Provider Contact Name:
Address Line 1:
Address Line 2:
City:	State:	ZIP Code:
Phone Number:	Email:

Course Requirements

Objectives

Outline the objectives of the training as they relate to social work practice and/or theory.

Subject Matter

The outline of the subject matter must correspond to each objective and must reflect appropriateness for continuing education for social workers.

As per N.D. Admin. Code, Board-approved continuing education course content must relate to: theories and concepts of human behavior and the social environment; social work knowledge and skills; social work research or practice evaluation; social work ethics; or cross disciplinary courses directly relevant to social work practice or specialty.

Licensees are required to earn 2 contact hours in social work ethics per 2-year licensure period.


Is any of the subject matter ethics related?	Yes	No
Number of Contact Hours:

Instructional Methods

List all methods which will be used; example: lecture, role play, PowerPoint, etc.

Licensees are limited to 10 contact hours earned via self-study or distance learning methods.

Presenter(s) Qualifications

Describe the criteria for selection of presenter(s) for your program.

Evaluation Methods

Identify the methods of evaluation that will be used to determine behavioral objectives have been met by the participant.

Please upload a copy of the evaluation form.

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Attachments

Please upload agenda/schedule/brochure with times listed to verify length.

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Please upload certificate of completion.

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Attendance Reporting

You will be responsible for issuing certificates of completion to all attendees stating the name and license number; also include on the certificate the title of the training, date of training, NDBSWE issued program approval number, and how many hours the attendee earned. The NDBSWE recommends you keep copies of the certificates or an attendance roster on file for 4 years. Failure to do so may result in future denial of program approval.

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Approved Program Status Application

Course Requirements

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