BEHAVIOR
ANALYST CERTIFICATION BOARD, INC.
TYPE 2 (APPROVED) CONTINUING EDUCATION (ACE) PROVIDER
ORGANIZATION APPLICATION
NAME
OF ORGANIZATION:
___________________________________________________________________
NAME OF PROPOSED ACE COORDINATOR FOR ORGANIZATION:
___________________________________________________________________
last first middle
ADDRESS OF PROPOSED ACE COORDINATOR:
__________________________________________________________________
Street/suite# city state/province country zip/postal code
PHONE: work (____) _____ - _______ x ____ home (____) _____ - ________
EMAIL ADDRESS OF PROPOSED ACE COORDINATOR: IMPORTANT - PRIMARY COMMUNICATION
MODE WITH BACB (1 letter per line)
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
_ Curriculum vitae of proposed ACE Coordinator is attached
_ Sample Type 2 CE syllabus is attached
_ $200.00 application fee made out to Behavior Analyst Certification Board is
enclosed
MAIL APPLICATION TO:
BACB c/o PTI
3323 Thomasville Road, Suite B
Tallahassee, Florida 32308
Providers MUST be approved by the BACB prior to offering any events for Type
2 continuing education. The BACB suggests that providers apply well in advance
of the first event they wish to offer.
All Type 2 continuing education (ACE) provider applicants MUST agree to the
following terms and conditions. The BACB will not review any application that
does not include a signature of agreement to all of the terms and conditions.
Any violation of these terms and conditions WILL result in immediate termination
of provider status.
1. BACB ACE providers may only represent that they are “BACB approved continuing
education providers.” The BACB forbids any other representations. BACB
ACE providers may not suggest or imply in any advertisements of their ACE events
that the BACB warrants, endorses, sponsors, or is otherwise affiliated with
(1) the continuing education event; (2) the organization offering or sponsoring
the event; or (3) the instructor of the event.
2. BACB ACE providers must ensure that all events offered for Type 2 (approved)
continuing education are consistent with all BACB Type 2 CE standards, criteria,
and policies, and that the events accurately portray the BACB standards, criteria,
and policies.
3. Prospective BACB ACE providers must not provide confidential information
during the application process. Information provided in this application may
be disclosed to third parties, including, but not limited to, state and federal
agents or agencies requesting such information.
4. BACB ACE providers are responsible for ensuring that all ACE events comply
with applicable laws, including facility licensure requirements and Americans
with Disabilities Act (or similar laws outside the United States) accommodation
requirements.
5. By signing below, the BACB ACE provider applicant affirms and represents
that the information provided in this application and any attachments hereto
is true and accurate. The applicant agrees to be bound by all BACB standards
and requirements for ACE providers, as may be revised. The applicant agrees
to indemnify and hold harmless the BACB, its directors, officers, employees,
agents and volunteers from and against any and all liability (including court
costs and attorney’s fees) that may arise from the BACB’s agreement
to process this application for approved continuing education providers and
any decisions or actions relating to this application, including, but not limited
to, approval decisions, renewal actions and decisions, denials of approved status,
and the issuance of sanctions regarding approval status.
AGREED:
___________________________________________ ___________
Signed Name of Proposed ACE Coordinator Date
___________________________________________ ___________
Printed Name Title
___________________________________________
BACB Certificant Number of Proposed ACE Coordinator