New York Physical Therapy Association Continuing Education Approval Office 15 North River Road, Tolland, CT (518)

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1 New York Physical Therapy Association Continuing Education Approval Office 15 North River Road, Tolland, CT (518) Continuing Education Approval by New York Physical Therapy Association Instructions All NY licensed Physical Therapists must take courses by a New York State approved provider. NYPTA is an approved provider for continuing education in New York State. Procedure: Complete application with all appropriate supporting materials: Helpful hints: Objectives need to be behavioral and measurable use this website as a guide References should be current (within past 5 years) and PEER REVIEWED Please include course schedule and break times for accurate CEHs granted. One course title and hours earned per application: Courses offered in a series must be submitted separately (attendees register for courses separately). Courses offered congruently on the same day and sponsored by one company / location (i.e. symposiums, Annual Conference) must be submitted separately. Submit to NYPTA Continuing Education Approval (Leahy Management, 15 North River Rd, Tolland, CT 06084). Applications may be sent electronically to address above. The review will not begin until payment is received. Checks made out to New York Physical Therapy Association. Applications will not be accepted if the course has already occurred. Application review will take approximately 2 weeks. Incomplete applications can be delayed. 5. Once approval is granted, you will receive the letter electronically. This course approval is good for one year from approval date. (See below for renewal process) by getting approved through NYPTA, you are entitled to a FREE listing on the NYPTA web calendar. Contact Bibiana Braun at bbraun@nypta.org for more information. 6. Once your course is complete, you must submit a list of attendees using the form provided. Please include course approval number on this form. Also, include course evaluations. Forward form and evaluations to NYPTA Chapter Office, 5 Palisades Drive, Suite 330, Albany, NY Certificates of completion / hours earned will be sent to attendees (electronically) from NYPTA Chapter Office, Albany NY, (lbrown@nypta.org) provided the form mentioned above is ed to Linda Brown with all pertinent information included. ***we are not responsible for the failure to receive the certificate by the participant if the address is incorrect.

2 Credit for Shortened Version of Approved Course If you would like to offer a shortened version of an approved course (6 hours approved but would like to offer a 3 hour version), please do the following: Complete application form include title and hours of shortened version Please send to NYPTA, 15 North River Road, Tolland, CT Objectives of shortened version must correlate with objectives of approved course Original Course schedule 5. Shortened Course schedule Please include a $50 processing fee Shortened course may use same references and instructors listed in initial approval Course Renewal If you are renewing a course that previously received NYPTA approval, you may submit a streamlined application. Please note any changes to the course and confirm that references still fall within 5 year time frame.

3 New York Physical Therapy Association Continuing Education Approval Office 15 North River Road, Tolland, CT (518) Requirement Checklist /District Application for Approval of Continuing Education Hours Sponsor Name: Contact Person: Phone: Fax: Address: Program Title: Date Location (city, state) Presenter(s) Tuition/Fees: CE Hours proposed (50 minutes equals 1 Hour): By submission of this application, I authorize payment* from District to NYPTA of the following amount: $40 (1-3 hours) $50 (4-7 hours) $60 (8 or more hours) District Authorization Signature *Fee is non-refundable, even if course is not approved. Expected number of participants: Please submit completed application, with all necessary supporting materials and appropriate fee, to the address noted at the top of this page.

4 Course Information: The following must accompany the application, except as noted: COURSE SPONSOR Name Organization Address Telephone Number Fax Number Address PROGRAM INFORMATION Title Date Location Fee Information Cancellation Policy TARGET AUDIENCE Basic Intermediate Advanced Various PROGRAM Contact Hours Objectives Course Outline Course Schedule Instructional Method Ratio Participant to Presenter (hands on workshop) Participant Evaluation of Program (course evaluation) Bibliography At a minimum, must contain at least 5 citations from reputable peer reviewed journals published within the past five years that support the content of the course. REQUIREMENTS OF PRESENTER(s) Current CV of presenter(s) UPON COMPLETION OF COURSE, PLEASE SEND THE FOLLOWING to Albany, NY: List of participants, including mailing address, license number Title of Program Date(s) of Course Location and presenters Course evaluations

5 For Official Office Use Only: Date Received: Fee Paid: Reviewer Comments: Approved Not Approved (Please note reason below) Approved contingent on the following: Reviewer Signature: Date: Reviewer Name (please print): Revised 3/18/11