OAMHP CEC Application Organization Information Organization * Contact First Name * Contact Last Name * Phone Number * Email Address * Website (if applicable) Have you been approved for OAMHP (OACCPP) CECs in the past: * Yes No Instructor Information Please demonstrate that the instructor has specialized knowledge of, and expertise in, the area in which they are providing CE instruction; and has ability and experience in teaching, which includes setting educational objectives and assessing learning outcomes. Instructor Name * Last Name * Phone Number * Email Address * OAMHP Number (if applicable) Summary of Qualifications * (maximum 250 charactors) Course/Workshop Information Course name * Learning Outcomes * Number of hours * 1 2 3 4 5 6 7 8 2 days 3 days 4 days 5 days > 1 week *One hour spent in a continuing education activity is equivalent to one CEC.**An activity can be granted up to a maximum of 6 CECs per full day. Brief description of scheduled activities * Course cost * Course location * Is the course offered online * Yes No My course promotes the development of the participant in (check all that apply): * Counselling Consulting Psychometry Psychotherapy Psychology Notes (optional): Has this course been approved with any other credit or school programme? * Yes No My course includes the following activities (check all that apply): * Supervisory activities: Participation in peer supervision or supervision by a qualified professional or provision of supervision to new members. Direct participatory activities: Participation in workshops or presentations related to one of the four identified professions or a related activity and structured course work in one of the four identified professions or related subject matter including on-line activities. Advancement of the profession: Participation in research activities, participation in governance committees for professional associations or colleges related to one of the four identified professions. Networking activities: social activities not which do involve a learning component. Personal therapy: including group therapy, participation in addiction treatment (including peer support groups) or individual/couple counselling (even if included as part of a professional program). Training in non-counselling/psychotherapy related issues: such as training in administrative issues, file management, or financial management even should such issues touch upon the provision of professional services. Activity Count Notes (optional): Payment Information The cost to submit an application for one CEC event or activity is $50.00+HST and is non-refundable. Payment Method * Pay Now via Credit Card Subtotal Subtotal: $ HST Tax: $ CEC Approval Fee Total Total: $ I agree to the terms of payment I acknowledge that I have read and agree to the terms of payment and understand that the OAMHP CEC Administration Fee is non-refundable.