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PART IV. CONTINUING EDUCATION TRACKER (Constant Contact)

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PLEASE SAVE TO YOUR LOCAL DEVICE PRIOR TO ENTERING DATA. ATTACH THIS CEU TRACKER
TO YOUR ONLINE RENEWAL APPLICATION WHEN MAKING YOUR CREDIT CARD PAYMENT AND
COMPLETING ONLINE, OR PRINT AND MAIL WITH YOUR RENEWAL APPLICATION.
Name: ______________________________________________________
Continuing Education tracker
Page 1
of 4
PART IV. CONTINUING EDUCATION TRACKER
Use the following grid to log your clock hours of continuing education completed for licensure renewal.
• In Section 1, enter the date of completion for the Arizona Statutes/Regulations tutorial (required). If you have not completed, click HERE.
• Report a
minimum of 30 hours total including a minimum of 3 hours of behavioral health ethics/mental health law (Section 2), and 3 hours of cultural competency
and diversity (Section 3).
• If you have a substance abuse counseling license, at least 20 hours must be in the categories listed in R4-6-802(E) (Section 4).
• To review the Board rules related to renewal of licensure, click HERE.
• ATTACH this tracker to your complete renewal application rather than rekeying all your courses.
REQUIREMENT
ACTIVITY
TYPE
ACTIVITY NAME
SPONSORING
ORGANIZATION
DESCRIPTION OF CONTENT
DATE(S)
ATTENDED
TOTAL
HOURS
SECTION 1
Board
Approved
Tutorial
O - online
course
Arizona Statutes/Regulations
Tutorial
Center for
Credentialing &
Education (CCE)
Board approved tutorial on Arizona Statutes and
Regulations
TOTAL 3.00
Select for Activity Type: O-online course, P-presentation by you, C-college course, W-workshop/conference, S-seminar, E-employer in-service training, B-AZBBHE board meeting attendance
REQUIREMENT
ACTIVITY
TYPE
SPONSORING
ORGANIZATION
DESCRIPTION OF CONTENT
DATE(S)
ATTENDED
TOTAL
HOURS
SECTION 2
Behavioral
health ethics
or mental
health law
(minimum of 3
clock hours)
If additional lines are needed for behavioral health ethics or mental health law clock hours, please key in the General section below (SECTION 5) TOTAL
The tutorial must be completed EACH renewal cycle.
Please enter your completion date ---->
3.00
Select
Select
Select
Select
Select
0.00
Continuing Education tracker
Page 2
of 4
Arizona Board of Beh
avioral Health Examiners (“Board”) renewal application Name: ______________________________________________________
Select for Activity Type: O-online course, P-presentation by you, C-college course, W-workshop/conference, S-seminar, E-employer in-service training, B-AZBBHE board meeting attendance
REQUIREMENT
ACTIVITY
TYPE
ACTIVITY NAME
SPONSORING
ORGANIZATION
DESCRIPTION OF CONTENT
DATE(S)
ATTENDED
TOTAL
HOURS
SECTION 3
Cultural
competency
and diversity
(minimum of 3
clock hours)
If additional lines are needed for cultural competency and diversity clock hours, please key in the General section below (SECTION 5) TOTAL
Select for Activity
Type: O-online course, P-presentation by you, C-college course, W-workshop/conference, S-seminar, E-employer in-service training, B-AZBBHE board meeting attendance
REQUIREMENT
ACTIVITY
TYPE
ACTIVITY NAME
SPONSORING
ORGANIZATION
DESCRIPTION OF CONTENT
DATE(S)
ATTENDED
TOTAL
HOURS
SECTION 4
Substance
abuse
focused
(minimum of
20 clock
hours - only
required
for
LSAT,
LASAC and
LISAC)
Select
Select
Select
Select
Select
0.00
Select
Select
Select
Select
Select
Select
Continuing Education tracker
Page 3
of 4
Arizona Board of Beh
avioral Health Examiners (“Board”) renewal application Name: ______________________________________________________
Select for Activity Type: O-online course, P-presentation by you, C-college course, W-workshop/conference, S-seminar, E-employer in-service training, B-AZBBHE board meeting attendance
REQUIREMENT
ACTIVITY
TYPE
ACTIVITY NAME
SPONSORING
ORGANIZATION
DESCRIPTION OF CONTENT
DATE(S)
ATTENDED
TOTAL
HOURS
SECTION 4
(continued)
Substance
abuse
focused
(minimum of
20 clock
If additional lines are needed for substance abuse focused clock hours, please key in the General section below (SECTION 5) TOTAL
Select for Activity Type: O-online course, P-presentation by you, C-college course, W-workshop/conference, S-seminar, E-employer in-service training, B-AZBBHE boa
rd meeting attendance
REQUIREMENT
ACTIVITY
TYPE
ACTIVITY NAME
SPONSORING
ORGANIZATION
DESCRIPTION OF CONTENT
DATE(S)
ATTENDED
TOTAL
HOURS
SECTION 5
General
courses
(not listed
above)
hours - only
required for
LSAT,
LASAC and
LISAC)
Select
Select
Select
Select
Select
Select
Select
0.00
Select
Select
Select
Select
Continuing Education tracker
Page 4
of 4
Arizona Board of Beh
avioral Health Examiners (“Board”) renewal application Name: ______________________________________________________
Select for Activity Type: O-online course, P-presentation by you, C-college course, W-workshop/conference, S-seminar, E-employer in-service training, B-AZBBHE board meeting attendance
REQUIREMENT
ACTIVITY
TYPE
ACTIVITY NAME
SPONSORING
ORGANIZATION
DESCRIPTION OF CONTENT
DATE(S)
ATTENDED
TOTAL
HOURS
SECTION 5
(continued)
General
courses
(not listed
above)
TOTAL
TOTAL ALL SECTIONS
Select
Select
Select
Select
Select
Select
Select
Select
Select
Select
Select
0.00
3.00
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PART IV. CONTINUING EDUCATION TRACKER (Constant Contact)

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Completed 12 January 2021

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