Continuing Education Program Proposal
REQUEST FOR CHAPTER PROGRAM APPROVAL
All proposals for continuing education must be submitted in the prescribed format below. Proposals must be
typewritten or word-processed. Handwritten proposals will not be accepted. Proposals must include all
criteria listed below and required attachments in order to be accepted. Proposals for medical errors courses
must be submitted at least 90 days in advance and all other topics at least 30 days in advance.
1. TITLE OF PROGRAM:
2. CHAPTER: Pull down, choose Chapter
3. PRESENTER(s) (attach Vita):
4. DATE OF PRESENTATION:
5. BEGINNING AND ENDING TIME:
6. NUMBER OF CE CREDITS:
General
Medical Errors
Professional Ethics & Florida Laws & Rules
Domestic Violence
7. LOCATION/ADDRESS (must be ADA compliant):
8. FEES: FPA Member: $
FPA Sustaining Member: $
FPA Non-Member: $
(Sustaining members must receive a 15% discount)
9. FEE REFUND POLICY:
10. TARGET AUDIENCE:
Psychologists
Marriage and Family Therapists
Students
Mental Health Counselors
Social Workers
other
11. PROGRAM CATEGORY: Indicate ONE of the following categories:
Introductory: Participants need no prior knowledge of your specific topic or content to
participate fully and effectively in the program. The information you are presenting or the
skills you are teaching will be unfamiliar to those enrolled although they will be practicing
mental health providers or active teachers/researchers.
Updated October 2014
Intermediate: Participants should have some basic knowledge of the specific content you
will cover, but need not have in-depth knowledge or skills. The program will provide
information at a level beyond the basic knowledge of the topic.
Advanced: To participate fully, those enrolled must possess a substantial working
knowledge or skill level in your specific content area. Generally, the knowledge or skill involved
is currently used by the participant in his/her job. At this level, advanced techniques or
knowledge would be offered to refine and expand current expertise.
12. DESCRIBE METHOD OF DETERMINING LEVEL OF PARTICIPANT? Licensure
13. DESCRIPTION OF PRESENTATION (please provide details):
14. IS THIS A NEW AND EMERGING CONTENT AREA?
YES
NO
15. REFERENCES/CITATIONS. Include 3 (scholarly) references/citations (in APA format) related to the topic.
A proposed CE program will not be rejected by the Committee solely for exclusively citing references self-authored by its
presenter, as long as the proposal further demonstrates adherence to Standard D of the Standards and Criteria for
Approval of Sponsors of Continuing Education for Psychologists.
(1)
(2)
(3)
16. THREE (3) WORKSHOP MEASURABLE LEARNING OBJECTIVES (see last page for additional instructions):
This workshop is designed to help you…
(1)
(2)
(3)
(4)
17. IS THE SPEAKER QUALIFIED TO ADDRESS THE TARGET AUDIENCE(S) IDENTIFIED?
YES
NO
18. DESCIBE PRESENTER’S EXPERTISE IN THE AREA OF THE PRESENTATION (please provide details):
19. DRAFT REGISTRATION ANNOUNCMENT OR BROCHURE ATTACHED?
YES
NO (Proposal will not be processed)
20. ETHICAL CONSIDERATIONS:
Please answer the following questions:
 Are you presenting information about individuals seen in your practice, participants in your
research or an organization?
Yes
No
o If yes, has privacy been safeguarded?
Yes
No
o If yes, in what form will you provide patient information?
o If yes, have all necessary permissions been obtained?
Yes
No
 Will you be discussing proprietary test materials or information?
Yes
No
Updated October 2014

o If yes, have appropriate steps been taken to assure the security and appropriate use of
the proprietary test materials or information?
Yes
No
o If yes, have all necessary written permissions been obtained from authors/publishers or
other sources?
Yes
No
Will audience participation be contingent upon signing a release form?
Yes
No
o If yes, you must attach release form to this proposal, and all forms must accompany any
advertisements for CEU session.
21. CHAPTER REPRESENTATIVE RESPONSIBLE FOR THIS PROGRAM:
No program will be approved if the advertisement has already been published and distributed. Every
announcement must provide the following endorsement language:
The Florida Psychological Association is approved by the Florida Department of Health, Board of Psychology to sponsor
continuing education for psychologists. The Florida Psychological Association is approved by the Board of Clinical Social
Work, Marriage and Family Therapy, and Mental Health Counseling as a provider of continuing education. The Florida
Psychological Association maintains responsibility for the program and its content.
PROGRAM PROPOSAL MUST BE RECEIVED
AT LEAST 30 DAYS BEFORE THE DATE OF PRESENTATION.
FPA CE PROPOSAL APPROVAL
408 Office Plaza Drive
Tallahassee, FL 32301
[email protected]
Updated October 2014
Writing Behavioral Learning Objectives and Assessments
(From APA Resources for Sponsors of CE Programming)
Learning objectives, or learning outcomes, are statements that clearly describe what the learner will know or
be able to do as a result of having attended an educational program or activity.
Learning objectives must be observable and measurable.
Learning objectives should (1) focus on the learner, and (2) contain action verbs that describe measurable
behaviors.
Verbs to consider when writing learning objectives:
 list, describe, recite, write
 compute, discuss, explain, predict
 apply, demonstrate, prepare, use
 analyze, design, select, utilize
 compile, create, plan, revise
 assess, compare, rate, critique
Verbs to avoid when writing learning objectives
 know, understand
 learn, appreciate
 become aware of, become familiar with
Example of well-written learning objectives:
This workshop is designed to help you:
1. Summarize basic hypnosis theory and technique;
2. Observe demonstrations of hypnotic technique and phenomena;
3. Recognize differences between acute and chronic pain;
4. Utilize hypnosis in controlling acute pain;
5. Apply post-hypnotic suggestions to chronic pain; and
6. Practice hypnotic technique in dyads.
Updated October 2014