CALIFORNIA CODE OF REGULATIONS - State of California

§ 1397.69 CALIFORNIA CODE OF REGULATIONS
Page 586
MCEP Course Application page 2 of 2
California Psychological Association Accrediting Agency
Please enclose the following documents.
√ Sample attendee list format √ Sample attendance certificate √ Signed After Course Agreement
B. Co–sponsorship
If this course, or the larger event this course is part of, is sponsored in full or in part by another organization, this section of the application
must be completed.
Identify the organization responsible for each of the following areas:
Course content
Course presentation
Course monitoring
Course records
Advertising/Marketing
Financial Arrangements
Administrative Policies
I certify, on behalf of _________________________________, that the preceding statements and the enclosed
provider organization
documents are true. I understand that any false statements may result in the revocation of provider approval. I understand that I am
responsible for maintaining all standards outlined in the provider application and that this course may be subject to either an unannounced
on–site course audit or an administrative audit.
Program Developer Signature
Date
Program Administrator Signature
Date
Both signatures are required to process application.
A non–refundable MCEP course application fee of $35, made payable to the California Psychological Association Accrediting Agency
must accompany 3 copies of the application including all attachments.
Check enclosed
Account #:
Please bill my credit card:
Visa Mastercard Discover American Express
Exp. Date:
Signature:
Completion of this form does not constitute MCEP course approval status. If granted, MCEP course approval will become effective on the
date set forth in the notification of approval letter.