Fill - Standard Application (Center for Credentialing & Education)

Human Services-Board Certied Practitioner revised 1-2015

TERRACE WAY

GREENSBORO, NC 27403-3660 USA

TEL: 336-482-2856 * FAX: 336-482-2852

www.cce-global.org * CredentialInfo@cce-global.org

The CCE Human Services-Board Certied Practitioner (HS-BCP) certication marks are owned by the Center for Credentialing

& Education, Inc. (CCE). CCE

is a registered trademark of the Center for Credentialing & Education, Inc.

The Center for Credentialing & Education, Inc. (CCE) values diversity.

There are no barriers to certication on the basis of gender, race, creed, age, sexual orientation or national origin.

APPLICATION PACKET

This application form is interactive.

Download the form to your computer to fill it out.

Human Services-Board Certi ied Practitioner revised 9-2015

About the Credential ................................................................ 3

What Is a Human Services-Board Certied Practitioner?

Competency Areas

CCE Ethics Policies and Procedures

Eligibility .................................................................................. 4

Education and Experience

Required Documentation

Examination

Applying for the HS-BCP ............................................................. 5

Maintaining the HS-BCP ............................................................. 6

HS-BCP Application Form ..................................................... 7–9

Verication of Experience Form .............................................. 10

Special Accommodations Request Form ................................ 11

Payment Voucher ...................................................................... 13

TABLE OF CONTENTS

Human Services-Board Certi ied Practitioner revised 9-2015

WHAT IS A HUMAN SERVICES-BOARD CERTIFIED PRACTITIONER?

The Human Services-Board Certied Practitioner (HS-BCP) certication is offered by the Center for Credentialing &

Education, Inc. (CCE). The National Organization for Human Services (NOHS), in consultation with the Council for Standards

in Human Service Education (CSHSE), worked with CCE to develop this certication. The HS-BCP is for qualifying human

services practitioners, including those holding associate, bachelor’s and advanced degrees.

CCE ETHICS POLICIES AND PROCEDURES

HS-BCP applicants and certicants are responsible for ensuring that their behavior adheres to the standards identied in the

HS-BCP Code of Ethics.

An applicant must complete all portions of the HS-BCP application, including the Ethics Attestation and the Applicant

Agreement & Release Authorization. Application disclosures and other ethics matters are reviewed in accordance with CCE

procedures. Disclosures do not automatically render an individual ineligible for certication. CCE reserves the right to deny

eligibility based on an ethics disclosure.

The Credential Eligibility Policy-Ethics, the CCE Ethics Case Procedures and the HS-BCP Code of Ethics are available for

your review on the CCE Web site at www.cce-global.org/Prof/Ethics.

ABOUT THE CREDENTIAL

COMPETENCY AREAS

1. Ethics in Helping Relationships

2. Interviewing and Intervention Skills

3. Group Work

4. Case Management

5. Human Development

6. Social and Cultural Issues

7. Social Problems

8. Assessment/Treatment Planning

9. Intervention Models/Theories

10. Human Behavior

11. Social Welfare and Public Policy

12. Research, Program Evaluation and Supervision

Human Services-Board Certi ied Practitioner revised 9-2015

EDUCATION AND EXPERIENCE

Degree* Experience Required**

Associate 3 years, including a minimum of 4,500 hours

Bachelor’s 2 years, including a minimum of 3,000 hours

Master’s or Higher 1 year, including a minimum of 1,500 hours

* In order to qualify, you must hold a degree from

a regionally accredited college or university, or a

state-approved community or junior college.

** Of the total hours required, at least half must be

obtained postdegree.

REQUIRED DOCUMENTATION

Transcript: An ofcial sealed transcript listing the qualifying degree is required. If you have recently graduated, do not

request a transcript until you know that the registrar has posted your degree.

Applicants with Non-U.S. Degrees: If you earned your degree(s) outside the United States, you will need to have the

degree(s) evaluated by an international transcript evaluation service and submit the results to CCE with your application.

CCE accepts evaluations completed by World Education Services, Inc.; Educational Credential Evaluators, Inc.; and the

American Association of Collegiate Registrars and Admissions Ofcers International Education Services.

Verication of Experience Form: The Verication of Experience Form, completed by your supervisor, human resources

ofcial or similar authority in your workplace, is required. The completed Verication of Experience Form is required for

all education levels except human services educators working in college or university settings and graduates of

CSHSE-accredited programs.

If your degree is in a eld other than human services, counseling, social work, psychology, marriage and family therapy,

or criminal justice, you must have completed a minimum of 15 semester hours (22 quarter hours) of coursework in three

or more of the 1

1 content areas listed below, including at least two semester hours (three quarter hours) in ethics in the

helping professions, two semester hours (three quarter hours) in interviewing and intervention skills, and two semester

hours (three quarter hours) in case management. The 11 content areas are:

7. Social Problems

8. Assessment/Treatment Planning

9. Intervention Models/Theories

10. Human Behavior

11. Social Welfare/Public Policy

1. Interviewing and Intervention Skills

2. Group Work

3. Case Management

4. Human Development

5. Ethics in the Helping Professions

6. Social and Cultural Issues

Human services educators (HSEs) with qualifying degrees who are currently employed in human services education

programs do not need to submit a Verication of Experience Form. In lieu of the form, HSEs must submit a statement on

letterhead from the department chair, provost or academic vice president attesting to their involvement with the human

services education program.

EXAMINATION

All applicants are required to pass the HS-BCP Examination (HS-BCPE) in order to successfully complete the application

process. You may submit an application at any time. Upon CCE’s approval of your application, examination registration

information will be e-mailed to you, and you will be eligible to register for the HS-BCPE.

ELIGIBILITY

Human Services-Board Certi ied Practitioner revised 9-2015

If you have questions regarding the HS-BCP application and credential, contact CCE:

Telephone:

336-482-2856

Fax: 336-482-2852

E-mail: CredentialInfo@cce-global.org

Information about all of CCE’s credentials is available at www.cce-global.org.

SUBMITTING YOUR APPLICATION

• Please be sure to include the application fee. (This fee is nonrefundable and nontransferable.)

• All application materials must be submitted in English.

• All application materials should be submitted to CCE in one packet.

• If you are mailing your application, be sure to make copies of all your application materials before submitting

the originals to CCE.

You have two options for submitting your application:

Mail: CCE

P.O. Box 77759

Greensboro, NC 27417-7759

Fax: 336-482-2852

APPLYING FOR THE HS-BCP

THE APPLICATION PROCESS

APPLICATION PROCESSING TIMELINE

Once your application is received, it will go through the following steps:

Processing Step Business Days

Payment processing and account setup 3–5

Data entry and application review* 12–13

Total Processing Time:

15–18

*All applications are reviewed in the order received. If your application requires review by the Ethics Department, or if

additional information is needed to complete the review, this step may take longer.

Human Services-Board Certi ied Practitioner revised 9-2015

CURRENT HS-BCP CREDENTIAL AND MAINTENANCE FEES

Fees are nonrefundable and nontransferrable.

Application fee: $210 (U.S. dollars)

Annual maintenance fee: $40

HS-BCP RECERTIFICATION REQUIREMENTS

The HS-BCP certication is valid for ve years as long as you comply with CCE policies and procedures. HS-BCP

certicants must pay annual maintenance fees and recertify at the end of ve years to maintain the certication. CCE will

mail you a recertification form approximately six weeks before the certification expiration date. In order to maintain the

certification, you need to satisfy the following requirements:

1. Complete 60 continuing education hours within the HS-BCP competency areas, including a minimum of six

hours specic to ethics. Each year, a random sample of 10 percent of all recertifying HS-BCPs is audited.

If you are selected for audit, you will need to submit copies of course attendance certicates and/or other

continuing education documentation.

2. Accept and sign the Ethics Attestation and Applicant Agreement & Release Authorization.

3. Pay the annual maintenance fee. Payment means you agree to continue to adhere to the HS-BCP Code of

Ethics and report any charge or complaint about a criminal, civil, state board or other professional disciplinary

matter(s) within 60 days of your knowledge of the complaint or charge.

MAINTAINING THE HS-BCP

HS-BCP REINSTATEMENT REQUIREMENTS

If your HS-BCP certication becomes inactive or expires, you will need to submit a reinstatement application along with

the following in order to retain it:

• HS-BCP reinstatement fee (currently $50)

• Payment of any past-due fees

• Documentation of 60 hours of continuing education (if expired)

Human Services-Board Certi ied Practitioner revised 9-2015

10. Examination: A passing score on the Human Services-Board Certied Practitioner Examination (HS-BCPE) is

required. If you took and passed the HS-BCPE through a participating school program within the last ve years,

provide the following information to transfer that passing score to this application.

Test Date: ______________________ School: ____________________________________________________

APPLICATION FORM

PAGE 1

5. Gender: � Male � Female

6. Date of Birth (mm/yyyy):

7. Ethnic Origin (optional—for statistical purposes only):

� African American � Native American � Asian � Caucasian

� Hispanic/Latino � Native Hawaiian � Multiracial � Other

9. How did you hear about the HS-BCP certication?

FOR OFFICE USE

ONLY

REF.#1:____________

BATCH #1: _________

DATE: _____________

AMOUNT:___________

1. First Name, MI:

Last Name:

Previous Name(s):

2. Street Address:

City, State/Province

ZIP/Postal Code, Country:

3. Home Telephone:

Business Telephone:

Fax:

4. E-mail:

� Check here if you do NOT want your contact information shared with continuing education providers.

PLEASE FILL OUT ELECTRONICALLY OR PRINT CLEARLY

8. I am interested in volunteering for � marketing efforts � examination development � standards development.

Human Services-Board Certi ied Practitioner revised 9-2015

11. Education/Degree (Enclose ofcial sealed transcript.):

Note: If registrar will not provide you with a sealed transcript, please have your ofcial sealed transcript sent directly

to CCE; Attn: HS-BCP Reviewer; 3 Terrace Way, Greensboro, NC 27403-3660. Include a brief note on the front of

your application stating that the transcript is being sent separately.

Provide information about your CSHSE degree or highest non-CSHSE degree that meets the educational

requirements detailed on page 4.

Degree Earned

Institution Name and City/State

Date Degree

Conferred

Name of Degree*

* e.g., Associate of Science in Human Services, Bachelor of Science in Social Work, etc.

12. Licenses/Certications/Registrations/Credentials/Memberships (Include copy of license/certicate.):

Issuing State or

Organization

License/Certicate/Membership Type

License/Certicate/

Membership Number

Issue Date

Expiration Date

13. Special Accommodations:

� Check this box if you are requesting special examination accommodations. Include the Special Examination

Accommodations Request Form and supporting documentation with your application. Requests that are not

accompanied by the required documentation cannot be approved. CCE’s Assessment Department will contact you

directly regarding special accommodations once you are approved to sit for the HS-BCPE.

The Council for Standards in Human Service Education (CSHSE) accredits human services degree programs. If your

degree program was accredited by CSHSE at the time of your graduation, you do not need to submit a Verication of

Experience Form.

You can verify your program’s status at http://cshse.org/accredited.html.

APPLICATION FORM

PAGE 2

Applicant’s Name: Date:

Human Services-Board Certi ied Practitioner revised 9-2015

14. Ethics Attestation:

(Please respond to each statement below)

1. Have you ever been or are you currently the subject of any public or private

complaint, investigation or professional disciplinary action, including licensure

board and membership matters?

2. Have you ever been or are you currently charged with any criminal offense?

3. Have you ever been or are you currently named in a civil or other legal action?

If you answered “YES” to any of the above questions, you must include a complete, detailed explanation related to

the response. You must also provide copies of relevant documentation, such as copies of the complaint, pleadings

and compliance with nal orders.

Place these materials in a sealed envelope marked “Attention: Ethics Department” and return with your application.

Failure to provide required information will delay the processing of your application.

15. Applicant Agreement & Release Authorization:

All information I provided in this application, including supporting documentation, is accurate and complete to the

best of my knowledge. If I have knowledge of any changes concerning my responses in this application, including my

responses in the Ethics Attestation, I agree to report this to CCE in writing within 60 days.

I agree that CCE has the right to contact any person or organization regarding this application, and I authorize

the release of any information requested by CCE to verify the accuracy. I understand that all application materials

become the property of CCE and will not be returned.

I understand that certication through CCE depends upon my fulllment of all required criteria and compliance with

CCE policies, which include the HS-BCP Code of Ethics and the CCE certication mark and trademark use policy. I

understand that certication does not create membership in CCE. I understand that CCE certication is personal to

me and may not be transferred to another individual or group.

I understand that professional biographical and certication data is considered to be public information and will be

made available in response to public inquiries. I agree that data related to my participation in HS-BCP certication

may be used for research and statistical purposes.

I recognize that any certication granted by CCE does not represent licensure or other authorization to practice

business activities for a fee. I release CCE from all liability and claims arising from any professional activity.

Signature: Date:

YES NO

APPLICATION FORM

PAGE 3

Applicant’s Name: Date:

Human Services-Board Certi ied Practitioner revised 9-2015

VERIFICATION OF EXPERIENCE FORM

Thank you. After you complete this form, please return it to the applicant.

INFORMATION BELOW TO BE COMPLETED BY EXPERIENCE VERIFIER

Please complete all information below.

I verify that the applicant named above worked in a human services position from _________ (mm/yyyy) to ________ (mm/yyyy)

AFTER completing his/her degree and completed ____________ total hours of work as a human services practitioner.

I verify that the total period of employment was from _______ (mm/yyyy) to _______ (mm/yyyy) and that the applicant completed

__________ total hours of work as a human services practitioner. This applicant was/is employed in the position of

(job title) ___________________________________________________________________________________________.

Briey identify and describe all work experience related to human services. _______________________________________

____________________________________________________________________________________________________________

______________________________________________________________________________________________

To the person verifying experience: Please provide the following information about yourself.

1. Verier’s name: ___________________________________________________________________________________

2. Agency/institution where you worked with the applicant: __________________________________________________

_________________________________________________________________________________________________

3. Your title at agency/institution where you worked with the applicant: _________________________________________

4. Your current telephone number (required): ______________________________________________________________

_____________________________________________________ ___________________________

Verier’s Signature Date

Applicant’s Name: Date:

PLEASE FILL OUT ELECTRONICALLY OR PRINT CLEARLY

NOTE: This form is not required of human services educators in college or university settings or

graduates of CSHSE-accredited programs.

I am applying to the Center for Credentialing & Education (CCE) for the Human Services-Board Certied Practitioner

(HS-BCP) certication. I am required to provide documentation of my postdegree work and total work hours as a human

services practitioner. Please complete the information below and return the form to me. My application cannot be

processed without this form.

My degree was conferred _________________ (mm/dd/yyyy).

_____________________________________________________ ___________________

Applicant’s Signature Date (mm/dd/yyyy)

Human Services-Board Certi ied Practitioner revised 9-2015

CCE’s Assessment Department will contact you directly regarding special accommodations once you are approved to sit

for the HS-BCP Examination.

Candidates With Disabilities

NOTE: There is no extra charge for these arrangements.

Identify briey the nature of your disability. Attach documentation from a qualied professional. Diagnosis must be

included in the documentation. Specify the special accommodations and/or arrangements you will need to complete the

HS-BCP Examination. Documentation may not be more than ve years old.

The information I have provided is accurate. I agree to provide any additional information requested by CCE.

Applicant’s Signature: __________________________________________________ Date: ______________________

Candidates for Whom English Is a Second Language

NOTE: Additional fees apply for ESL applicants. For information on fees, contact CCE before applying.

I request extended time for the HS-BCP Examination because English is not my native language.

Applicant’s Signature: __________________________________________________ Date: ______________________

SPECIAL ACCOMMODATIONS

REQUEST FORM

Applicant’s Name: Date:

Human Services-Board Certi ied Practitioner revised 9-2015

This page was intentionally left blank.

Human Services-Board Certi ied Practitioner revised 9-2015

CURRENT APPLICATION FEES

Total Fee: $210 (includes the application fee and the examination fee)

• All fees must be paid in U.S. dollars and are nonrefundable.

• Once your payment has been processed, CCE will review your application within approximately

10 business days.

• You will be notied of your status and informed if further information is needed.

• The fee is waived if you are transferring a passing score on the HS-BCPE taken through a participating

school program.

• CCE holds applications open for three years. During that time, you will have the opportunity to rectify any

deciencies concerning your application.

APPLICATION CHECKLIST

Before submitting your completed application packet, make sure that you have included the following:

□ Application Form

□ Verication of Experience Form (not required of human services educators or graduates of a

CSHSE-accredited program)

□ Transcript for CSHSE or highest non-CSHSE degree that meets the educational requirements

detailed in this application

□ Application fee and Payment Voucher

METHOD OF PAYMENT

Telephone: Day:

Applicant’s Name:

Evening:

□ Please transfer HS-BCPE score. No payment required.

□ Enclosed is a check or money order payable to CCE in the amount of $210 (U.S. dollars).

□ Please charge the credit card listed below in the amount of $210 (U.S. dollars).

Cardholder Signature: ______________________________________ Date (mm/dd/yyyy): ____________

Account

Number:

Card Security Code (from back of card):

Name on Card:

Card Type:

VISA

MasterCard

American Express

Expiration

Date:

PAYMENT VOUCHER

Applicant’s Name: Date:

Submit your application and payment

• By mail: CCE; P.O. Box 77759; Greensboro, NC 27417-7759

• By fax: 336-482-2852

If you are mailing your application, be sure to make copies of all your application materials before submitting the

originals. CCE cannot return any forms or documents to you or to a third party.

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