Fillable 2021 Continuing Education Provider Application (NASM)

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2021 Continuing Education Provider Application (NASM)

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The 2021 Continuing Education Provider Application (NASM) form is 3 pages long and contains:

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  • 33 check-boxes
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Page | 1
2021 Continuing Education Provider Application
Thank you for your interest in becoming a Continuing Education Provider.
NASM and AFAA support ongoing professional development and education by requiring members to recertify
every two years. To qualify, members must complete Continuing Education Units (CEUs) from approved providers.
CEUs are awarded based on the number of hours spent in a structured educational format. Within this application,
continuing education providers may apply to be a NASM or AFAA approved provider or an approved provider for
BOTH at a discounted rate.
Once approved:
• Your Continuing Education (CE) Offering(s) and a link to your website, if provided, will appear on the
online CEU Approved Provider List. These lists are located at www.nasm.org or at www.afaa.com. Note:
NASM and AFAA have separate lists.
• The CEU value (with the associated recertification point system) will be posted on the CEU Approved
Provider List.
• You will receive instructions for the authorized use of the associated logo(s).
• Approval is awarded for a specific CE Offering for a specific calendar year.
CE Providers must demonstrate the following:
• Health and Fitness Topical Relevance (i.e. anatomy, nutrition, weight control, wellness, sports medicine,
business management, exercise assessment, fitness program design, special populations, strength
training, kinesiology, biomechanics, behavioral change, sports psychology, exercise physiology)
• Credible Content (i.e. proven/scientifically valid information and/or practical application/methods) that is
current and unique, at an appropriate level (designed for experienced fitness professionals) and aligned
with the mission and reputations of NASM and/or AFAA.
• Author/Instructor Credentials and Related Experience (i.e. certification, accreditation, and/or related
degree)
HOW TO APPLY:
1. Complete one Continuing Education Provider Application for each CE Offering.
2. Please include the following supporting documentation:
___Certificate of Completion
___Course outline or agenda
___Examples of course content (home study materials or slides)
___Instructor resume or bio
___Course objectives (if applicable)
___Referenced text material (if applicable)
3. Submit your completed application(s), supporting documentation and sample completion certificate(s) to
providerprogram@nasm.org.
4. We will contact you by phone within 2-3 business days to obtain your payment. If we are unable to reach you by
phone, we will contact you via email.
5. If you have questions, please contact us at 800.460.6276.
Page | 2
Please complete one application per course.
PROVIDER COMPANY NAME (Must match completion certificate name) __________________________________
HAS THIS PROVIDER BEEN PREVIOUSLY APPROVED BY NASM or AFAA? NO ________ YES __________
If yes: NASM PROVIDER # __________________ AFAA PROVIDER # ____________________
CONTACT NAME First/Last _______________________________________________________________________
PROVIDER ADDRESS Street/City/State/ZIP ___________________________________________________________
PROVIDER PHONE _______________________________ CONTACT PHONE _______________________________
PROVIDER EMAIL ________________________________ CONTACT EMAIL _______________________________
WEBSITE The link for the approved provider list(s) ____________________________________________________
CE OFFERING NAME Exactly as listed on the completion certificate
___________________________________________
# OF STRUCTURED CE OFFERING HOURS (excluding breaks)_______________
SUBJECT AREA MOST APPLICABLE TO COURSE (PLEASE SELECT ONLY ONE):
____ ANATOMY
____ EXERCISE PHYSIOLOGY
____ SPECIAL POPULATION
____ BIOMECHANICS
____ KINESIOLOGY
____ SPORTS PSYCHOLOGY
____ BUSINESS MANAGEMENT
____ NUTRITION EDUCATION
____ STRENGTH TRAINING
____ EXERCISE ASSESSMENT
____ NUTRITION/WEIGHT CONTROL
DESCRIBE THE CE CONTENT
Please describe course content below and provide access for online courses. If not available online, provide
documentation of your course for review and approval. Include copies of: sample materials, agendas, certificate of
completion.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
DESCRIBE CREDENTIALS OF AUTHOR(S)/PRESENTER(S)
Please provide resumes for all individuals responsible for the creation or instruction of course material.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Page | 3
CE OFFERING DELIVERY (CHOOSE ONE):
SELF STUDY _____ WORKSHOP ______ CONFERENCE ______ # OF CONFERENCE SESSIONS_____
FOR SELF STUDY, PLEASE PROVIDE THE FOLLOWING:
MATERIAL (# of PAGES)
QUIZ (# of ITEMS)
MEDIA (# of MINs)
LOGIN (Username/Password)
FOR A WORKSHOP OR CONFERENCE, PLEASE LIST LOCATION(S)/DATE(S):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2021 FEE CALCULATION BEST VALUE!
NASM Provider
AFAA Provider
NASM and AFAA
SUB-TOTAL
Fee
Select
Fee
Select
Fee
Select
$200
$200
$350
$
$200
$200
$350
$
$50
$50
$80
$
$300
$300
$450
$
$500
$500
$800
$
$650
$650
$950
$
TOTAL FEE
$
*Applicable to live in person or live virtual workshops/conferences.
**Series pricing applies to CE Offerings grouped together to create a course progression. First CE
Offering is full price and each subsequent course is series pricing.
TERMS
Please allow 30 days for processing. We can only process paid in full applications. We will attempt to
contact you by email if your application is incomplete. If your application remains incomplete after 60
days from the date of submission or is not approved, your request will be cancelled. We reserve the
right to cancel the Approved Provider status at any time.
I verify that I have read and agree to the Provider Terms and Conditions.
Applicant Signature:________________________________________________ Date: ____________
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2021 Continuing Education Provider Application (NASM)

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Completed 1 March 2021

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