DOCUMENT B
APPLICATION FOR CERTIFICATION DOCUMENT
to become European Fluency Specialist
1. Purpose of the form
The purpose of this document is
-to inform the European Fluency Specialist Board of the individual’s readiness to become a certified
European Fluency Specialist;
-to provide the Board proof of accomplishment of the required activities to become a European Fluency
Specialist.
2. Applicant identification
Name:
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Address:
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Street:
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City/Zip:
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Country:
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Phone:
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Email:
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Website:
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3. Professional activities
I attest that I have accumulated a min. 80 hours of clinical and/or academic work over a period of
maximum 3 years1. It concerns activities that were actively delivered (e.g., treating a client, supervising
students, giving a workshop, giving a Bachelor or Master course on fluency disorders, publishing an
article).
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Exemptions may be granted by the committee based on written requests to the European Fluency Specialist Board.
Document B: Application for certification document
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Clinical work should be documented in the specified logbook (Appendix A). These activities can
include prevention, assessment, intervention, clinical supervision/mentoring fluency trainees, referrals,
consulting. The clinical work adheres to country-specific clinical guidelines, code of ethics and
professional standards (see e.g., Royal College clinical guidelines)
Academic work should be documented in the specified overview document (Appendix B). These
activities can include lecturing courses on fluency disorders, supervising Ba/Ma-theses on fluency
disorders, publications, presentations, …).
Overview
Amount of clinical work:
And/or
Amount of academic work:
…….. hours
…….. hours
Total amount of professional activities: …….. hours
4. Continued professional development
The attached documents provide proof of continued professional development activities for a minimum
of 35 hours, gathered over a period of maximum 3 years2. It includes intervision activities and/or
activities that I have attended (e.g., following courses, workshops, symposia, NVST supervision sessions).
Examples of these activities are given in Appendix C. For each of these activities you must provide a) a
summary and b) proof.
5. Informal discussion groups3 on fluency disorders
I attest that I have participated for a min. 10 hours of discussion group activities over a period of
maximum 3 years4. This should be documented in the specified overview document (Appendix D).
6. Fee
Before certification documents will be processed, a payment of €100 (non-refundable) is required. After
payment (always before September 1st), Document B will be processed and European Fluency Specialist
status can be awarded.
7. Timing
Document B has to be sent in before September 1st of the year. The European Fluency Specialists Board
will notify applicants within a period of 2 months after application for certification.
Signature
_____________________________
Date
_____________________________
Exemptions may be granted by the committee based on written requests.
Case discussions, article discussions, discussions on attended lectures, courses, journal clubs, SIGs… min. 2 people, preferably small
groups, face to face or online. NVST members: participation to NVST quality circles is equivalent.
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Exemptions may be granted by the committee based on written requests
Document B: Application for certification document
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