To register, you must show proof of completion of a
9-Hour pre-registration (orientation) course approved by CCAPP
Return this application by mail or fax to receive the
educational material to fulfill the nine (9) hour
requirement to become registered.
Course materials will be e-mailed to you.
A valid e-mail is required!
TRAINING DETAILS
PRE-REGISTRATION
REQUIRMENTS
Get this course for $50, which includes a free registration as an RADT- I with
CCAPP for one year (a $40.00 value).
Checks must be made payable to CCAPP. If you have any questions, please email
[email protected].
Beginning March 1, 2014, prior to
registering with a certifying organization
(CCAPP, CAARR, CAADE and CADTP),
a person shall complete a nine-hour
orientation course consisting of three
hours each of ethics, professional
boundaries, and confidentiality. Each
certifying organization shall require preregistrants to take the orientation course
from an approved education provider.
REGISTRATION FORM
Name: _______________________________________
Address: _____________________________________
City: ________________________________________
State: _____________________ Zip: _____________
Home Phone: (______) _________________________ Work Phone: (_______) _______________
The nine hours of education specified in
the orientation course shall not count
toward fulfillment of the minimum 155
hours of alcohol and other drug education
required to become certified.
Email: _________________________
METHOD OF PAYMENT
Amount enclosed $______________
COURSE
DESCRIPTION
□ Check (make out to CCAPP Educational Institute) □ MasterCard □ Visa □ Discover □ American
Express
Credit Card #_______________________________
CCAPP is pleased to present this
3 Digit Security Code (on back of card) ______________
counselor pre-registration course. This
Expiration Date: ____________Signature: ________________________________________
innovative learning program will allow you
to read material at your own pace and
***A $30 fee will be charged for all returned checks or declined credit cards, and certificates will not be sent until payment is
receive CCAPP-approved counselor prereceived. CCAPP has a no refund policy.
registration course hours in the process.
Fax or Mail
The purpose of the program is to give you
Registration form and fees to:
educational material to fulfill nine (9) hours
of education required to become
FAX: 916.368.9424, or
registered. The course is self-paced so
you are not required to complete the
Mail: P.O Box 214127, CA 95821
material on any schedule, nowhere to go
and there are no deadlines or due dates.
THIS COURSE IS HOME STUDY TRAINING!
P.O Box 214127, Sacramento, CA 95821
Tel 916.368.9412 www.ccapp.us