Fillable KENTUCKY BOARD OF LICENSURE FOR MASSAGE THERAPY CONTINUING (Commonwealth of Kentucky)

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KENTUCKY BOARD OF LICENSURE FOR MASSAGE THERAPY CONTINUING (Commonwealth of Kentucky)

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BROWSE COMMONWEALTH OF KENTUCKY (KY) FORMS

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KENTUCKY BOARD OF LICENSURE FOR MASSAGE THERAPY
P.O. Box 1360, Frankfort, Kentucky 40602 ~ 911 Leawood Drive, Frankfort, Kentucky 40601
(502)564-3296 Extension 240 ~ http://finance.ky.gov/bmt/
CONTINUING EDUCATIONAL APPROVAL FORM
The Kentucky State Board of Licensure for Massage Therapy and its Continuing Education Committee will use the
following criteria in approving any program for continuing education credit. Please be sure that all of these criteria are
addressed in your application form or its attachments. The program sponsor shall send a program syllabus, sample
evaluation form, program outline, vitae of presenters, and a copy of the certificate for participants with the application
form.
The program must have a clearly stated purpose and defined content area consistent with the overall
goals of continuing education; namely, improvement of professional competency, acquisition of new
skills and knowledge, and strengthening habits of critical inquiry and balanced judgment.
The presenters must be professionals qualified in the defined content area.
The program’s time must be clearly stated in number of hours of attendance.
The number of hours requested for approval must be indicated on the form.
Attendance must be recorded by the program sponsor.
Documentation of completion must be provided to the participant.
Participants must be required to complete an evaluation of the program.
INSTRUCTIONS
1. This application is to be used with Microsoft Word.
2. Press the TAB key to skip to the next field.
3. The completed form may be submitted to the Kentucky Board of Licensure for Massage Therapy either by mail to
P.O. Box 1360, Frankfort, Kentucky 40602 or by delivery to 911 Leawood Drive, Frankfort, Kentucky 40601.
KENTUCKY BOARD OF LICENSURE FOR MASSAGE THERAPY
COMMONWEALTH OF KENTUCKY
PO BOX 1360
FRANKFORT, KY 40602
CONTINUING EDUCATION PROGRAM APPLICATION
Sponsor Name and Address:
Title of Program:
Instructor(s):
Location of Program Offering:
Date(s): Time: Number of Hours:
Educational Objectives: Briefly describe ways that your program will contribute to one or more of the following definitions of “continuing
education”: a) improvement of the licensee’s professional knowledge; b) acquisition of new skills and knowledge that will help maintain
competence; or c) strengthening of the habits of critical inquiry and balanced judgment.
What are the specific educational objectives of your program:
Content, Activities, and Materials:
Evaluation Procedures: (Attach copy of evaluation form to be used)
Intended Audience:
Intended Number of Participants:
Signed: Date:
FOR BOARD USE ONLY
Approved Denied Date:
By: No. of Hours:
Reason if Denied:
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KENTUCKY BOARD OF LICENSURE FOR MASSAGE THERAPY CONTINUING (Commonwealth of Kentucky)

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Completed 19 October 2021

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