Master's Level. Addiction. Professional (MCAP) Define Yourself as a Professional through Certification. Addiction. This booklet includes:

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1 Addiction Master's Level Addiction Professional (MCAP) This booklet includes: 1. Easy to follow instructions. 2. Your personal application form. 3. Mandatory forms to collect training documents and recommendations. Define Yourself as a Professional through Certification.

2 About Us Preface The Florida Certification Board (FCB) is a nationally recognized, non-profit professional credentialing organization that has been operating in Florida for over 30 years. It currently credentials over 15,000 individuals working in the related fields of addictions, prevention, criminal justice, mental health, child welfare and behavioral health. The FCB adheres to the highest industry psychometric standards for developing, implementing and administering certification programs and examination instruments. Once certified, each professional is required to strictly observe a Code of Ethical and Professional Conduct and participate in annual continuing education events. Mission The FCB serves the public interest by developing, administering and maintaining certification programs that reflect current standards of competent practice for health and human services professionals. Our mission is to protect the health, safety, and welfare of the citizens of Florida by regulating our certified professionals through experience, education, and compliance with professional and ethical standards. Property of the Board Materials submitted to the FCB as part of the certification process are considered property of the Florida Certification Board. Materials include but are not limited to applications, evaluations, transcripts, and certificates. Applicants are encouraged to keep copies of all materials and paperwork submitted for certification. Certification wall certificates and wallet cards are the property of the FCB and must be surrendered upon Board request. Board Policy and Procedures All FCB requirements, policies and procedures are maintained on our website at Applicants and certified professionals are individually responsible for ensuring they are following current FCB policy and procedures.

3 Candidate Guide Target Audience This MCAP Candidate Guide is written for the applicant who is not currently a: Physician or physician s assistant licensed under Chapters 458 or 459, F.S. Professional licensed under Chapters 490 or 491, F.S. Psychiatric Advanced Registered Nurse Practitioner (ARNP) licensed under Part 1 of Chapter 464, F.S. and meeting the Board of Nursing requirements for a Psychiatric ARNP designation. Certified Addiction Professional (CAP) Please see the MCAP Upgrade Application if you are a current Certified Addiction Professional (CAP). Please see the MCAP for Licensed Professionals Candidate Guide if you are currently a: A physician or physician s assistant licensed under Chapters 458 or 459, F.S. A professional licensed under Chapters 490 or 491, F.S. A Psychiatric Advanced Registered Nurse Practitioner (ARNP) licensed under Part 1 of Chapter 464, F.S. and meeting the Board of Nursing requirements for a Psychiatric ARNP designation. Publication and Revision History Original Publication: September 1, 2015 MCAP Candidate Guide Page 2 of 30 Effective Date: September 1, 2015

4 About Us...1 Preface... 1 Mission... 1 Property of the Board... 1 Board Policy and Procedures... 1 Candidate Guide Target Audience... 2 Publication and Revision History... 2 Certification Process, Standards & Requirements Overview...5 The Certified Master s Level Addiction Professional (MCAP) Credential... 5 Certification Process Overview... 5 MCAP Certification Standards... 2 International Certification and Reciprocity Consortium (IC&RC) Alcohol and Drug Counselor (ADC) Credential... 4 Fee Schedule... 5 Electronic vs. Manual Application... 6 Online Certification System Registration... 7 Step 1: MCAP Application Portfolio...8 Who Completes Which Form?... 8 MCAP Application for Certification: Online Submission... 9 Tips for Online Application... 9 MCAP Application for Certification: Manual Submission FCB Accept/Deny Criteria MCAP Application Sections Training Verification Form Requirement Supporting Documentation Requirements How to Calculate Training Hours Documentation and Submission Protocol FCB Accept/Deny Criteria Related Work Experience Verification Form Requirement Documentation and Submission Protocol How to Calculate Related Work Experience Hours MCAP Candidate Guide Page 3 of 30 Effective Date: September 1, 2015

5 FCB Accept/Deny Criteria On-the-Job Supervision Verification Form Requirement Documentation and Submission Protocol How to Calculate On-the-Job Supervision Hours FCB Accept/Deny Criteria Recommendation for Certification Form Requirement Documentation and Submission Protocol FCB Accept/Deny Criteria Step 2: Examination Process Requirement How, when and where is the MCAP Exam administered? Exam Registration Approval, Pre-registration & Registration Process Pre-registration Taking the MCAP Exam Score Reporting Rescheduling, Cancelling, and Missed Exams Examination Rules and Security Step 3: Certification Award, Continuing Education & Renewal Certification Award Continuing Education Requirement FCB Recognized and Approved Continuing Education Providers How to Document Compliance with CEU Requirements How to Calculate CEU Hours FCB CEU Accept/Deny Criteria Credential Renewal Renewal Notice Process FCB Appeal Process MCAP Mandatory Forms MCAP Candidate Guide Page 4 of 30 Effective Date: September 1, 2015

6 Certification Process, Standards & Requirements Overview The Certified Master s Level Addiction Professional (MCAP) Credential A Certified Master s Level Addiction Professional (MCAP) designation is a professional substance abuse credential for persons who hold a minimum of a Master s degree in a related field and have demonstrated competency through training, experience and clinical supervision in the performance domains of: Clinical Evaluation Treatment Planning Counseling Case Management and Referral Client, Family and Community Education Documentation Ethical and Professional Responsibilities Supervision Individuals holding the MCAP are recognized/hold the practice rights of a qualified professional per Chapter 397, F.S. Certification Process Overview Earning a professional credential is a multi-step process. This Certified Master s Level Addiction Professional (MCAP) Candidate Guide provides certification program standards, policy requirements and mandatory application forms. If you are a current qualified professional per Chapter 397, F.S., please see either the MCAP Upgrade Application OR the MCAP for Licensed Professionals Candidate Guide. Please carefully read this entire document PRIOR to applying for certification as certification application fees are non-refundable. Application Portfolio Examination Process Certification Award Maintenance and Renewal Step 1: Application Portfolio. During the first step, applicants submit a MCAP Application Portfolio for approval. The MCAP Application Portfolio is a compilation of mandatory forms and support documentation that, when taken together, provides verifiable documentation that the applicant has met the education, training, and experience standards necessary for certification. Step 2: Examination Process. After the MCAP Application Portfolio is approved, the applicant MCAP Candidate Guide Page 5 of 30 Effective Date: September 1, 2015

7 is allowed to register for and take the Certified Master s Level Addiction Professional written exam. Step 3: Certification Award. When the exam is passed, the applicant becomes a certified professional and enters the annual Maintenance and Renewal phase. Applicants have 12-months from the date the Certified Master s Level Addiction Professional Application and applicable fee(s) are received at the FCB office to earn the MCAP credential. The FCB will provide eligible applicants with directions to continue the certification process if the out-of-time date is reached. MCAP Certification Standards The following table provides an overview of the certification standards and requirements to earn and maintain Certified Master s Level Addiction Professional (MCAP) certification. Please read the remainder of this document for detailed policy guidance. TOPIC Formal Education If your degree is not specified, review the MCAP Related Degree Appeal Policy before applying as CERTIFICATION APPLICATION FEES ARE NONREFUNDABLE. The policy is posted on the FCB website at: rd.org/resources/policyand-procedure/ Content-Specific Training MINIMUM REQUIREMENT MCAP applicants must hold a minimum of a Master s degree in a related field. Related fields are: Counseling, to include: Addiction Studies/Counseling Marriage and Family Counseling Mental Health Counseling Pastoral Counseling Rehabilitation Counseling Recreational Therapy/Counseling Psychology, to include: Art Therapy Music Therapy Expressive Arts Therapy Social Work Advanced Nurse Practitioner with psychiatric specialty Eligible degrees are issued by educational institutions holding United States Department of Education and/or the Council on Higher Education Accreditation (CHEA) recognized accreditation at the time of degree award. An official transcript must be submitted to the FCB by the degree-granting institution. 350 total clock hours of training divided as follows: 1. Clinical Evaluation: 35 hours 2. Treatment Planning: 30 hours 3. Counseling: 50 hours 4. Case Management and Referral: 15 hours 5. Client, Family and Community Education: 15 hours MCAP Candidate Guide Page 2 of 30 Effective Date: September 1, 2015

8 TOPIC Related Work Experience On-the-Job Supervision Recommendations Written Exam Criminal Background Code of Ethics Continuing Education Renewal MINIMUM REQUIREMENT 6. Documentation: 15 hours 7. Ethical and Professional Responsibilities: 30 hours 8. Supervision: 16 hours 9. Understanding Addiction/Treatment Knowledge: 80 hours 10. Application to Practice/Professional Readiness: 64 hours* *Must include at least 4 hours of HIV-AIDS and 2 hours of Domestic Violence. Eligible training was taken in the last 10-years (no time limit on college coursework taken as part of a degree program). Documentation must be submitted to the FCB by the applicant. 4,000 hours (approximately 2 years of full-time work) of addiction-specific, professional-level work experience. Eligible experience occurred within the last 10-years. Documentation must be submitted to the FCB by the applicant s employer(s). 200 hours of direct supervision of the applicant s performance of addictionrelated services at the level expected of a MCAP. Of the 200 hours, a minimum of 20 hours of supervision must be provided and documented for each performance domain. Eligible supervision is provided and documented by a qualified supervisor and occurred within the last 10-years. Documentation must be submitted to the FCB by the applicant s supervisor(s). 3 professional letters of recommendation for certification. Documentation must be submitted to the FCB by the individual providing the recommendation. Florida Certified Master s Level Addiction Professional Exam (required) IC&RC ADC Exam (only required for those seeking international reciprocity.) Must have a clean criminal history for a minimum of 3-years prior to application for certification, including release from all sanctions. Must read and sign an attestation agreeing to comply with the FCB Code of Ethical & Professional Conduct. 20 hours per year. Training content must be related to at least one of the MCAP performance domains. CEU hours must be non-repetitive (i.e., the same course cannot be claimed more than one time during each credentialed period, even if the course was taken annually.) Annual, on June 30 th of each calendar year. MCAP Candidate Guide Page 3 of 30 Effective Date: September 1, 2015

9 International Certification and Reciprocity Consortium (IC&RC) Alcohol and Drug Counselor (ADC) Credential The Florida Certification Board is a proud member of the International Certification & Reciprocity Consortium (IC&RC). The IC&RC is a not-for-profit voluntary membership organization comprised of certifying agencies involved in credentialing or licensing alcohol and other drug abuse counselors, clinical supervisors, prevention specialists, co-occurring disorders professionals and criminal justice professionals. IC&RC and its members are committed to public protection through the establishment of quality, competency-based certification programs for professionals engaged in the prevention and treatment of addictions and related problems. The IC&RC also promotes the establishment and recognition of minimum standards to provide reciprocity for certified professionals. Individuals who hold IC&RC credentials are able to transfer their credentials to any of the IC&RC's 73 member organizations. The FCB offers two IC&RC credentials: IC&RC Alcohol and Drug Counselor (ADC) credential IC&RC Prevention Specialist (CPS) credential Certified Master s Level Addiction Professional (MCAP) applicants are eligible to earn IC&RC s Alcohol and Drug Counselor (ADC) credential. The minimum standards required for IC&RC ADC certification are met when the applicant has an approved MCAP certification application AND has earned a passing score on the IC&RC ADC exam. To apply for the IC&RC ADC Credential, complete the following steps: 1. Indicate I am seeking IC&RC ADC certification on the MCAP Application for Certification Form. 2. Your certification specialist will let you know when it is time to register for the IC&RC ADC exam. The fee is $185 per IC&RC test attempt. Exam approval and registration procedures are exactly the same as for the FCB required exams as described in this guide. 3. Complete the annual renewal process. IC&RC ADC credentials renew on June 30 th of each calendar year, in conjunction with the MCAP credential. The fee is $35 per year. MCAP applicants in good standing who are not already IC&RC certified may contact the FCB at any time to register for the IC&RC exam. MCAP Candidate Guide Page 4 of 30 Effective Date: September 1, 2015

10 Fee Schedule The following table lists mandatory and optional MCAP-related fees. In the event of a fee change, the fees posted online at take priority. ALL FEES ARE NON-REFUNDABLE Requirement Certification Application Fee Certified Master s Level Addiction Professional Exam Fee OPTIONAL EXAM International Certification and Reciprocity Consortium (IC&RC) Alcohol and Drug Counselor (ADC) Exam Fee MCAP Annual Renewal Fee Criminal Background Report Fee Manual Credit Card Processing Fee Manual Application Processing Fee Late Renewal Fee Fee $150. This fee is valid for a 12-month period. If the MCAP credential is not earned within 12-months of paying the certification application fee, a $150 continuation fee must be paid. This fee must be paid before the Certified Master s Level Addiction Professional Application will be assigned to a certification specialist for processing. $150. This fee must be paid with every exam attempt. DO NOT PAY THIS FEE UNTIL YOU ARE APPROVED TO TEST BY AN FCB CERTIFICATION SPECIALIST. The FCB will not refund exam fees if you are not approved to test. $185. This fee must be paid with every IC&RC ADC exam attempt. DO NOT PAY THIS FEE UNTIL YOU ARE APPROVED TO TEST BY AN FCB CERTIFICATION SPECIALIST. The FCB will not refund exam fees if you are not approved to test. $125. This fee must be paid before June 30th of each calendar year. $20. This fee is required for any applicant who answers, Yes, I have had a felony or second degree misdemeanor charge in my past on the Certified Master s Level Addiction Professional Application. This fee covers the cost to the FCB to run a criminal history report. $5. Online credit card payments do not have an additional fee. This fee is charged for any credit card payment manually processed by the FCB. $25. This fee is required for any manual, hard-copy applications submitted to the FCB. The fee covers the cost of data entry. This fee must be paid before the Certified Master s Level Addiction Professional Application will be entered into the FCB certification database and assigned to a certification specialist for processing. $50. This fee must be paid in addition to renewal payments submitted between July 1st and July 31st of each calendar year. MCAP Candidate Guide Page 5 of 30 Effective Date: September 1, 2015

11 Electronic vs. Manual Application The FCB accepts both electronic and hard-copy applications for certification, however: 1. ALL APPLICANTS MUST CREATE AN ACCOUNT to access the FCB s online certification system. 2. There is a $25 additional fee for manual applications. It is important to understand that the certification application process will never become totally paperless. Some documents and forms must be received in hard copy and uploaded to the database by FCB Certification Specialists. The Certified Master s Level Addiction Professional Application and all other mandatory forms are posted on the FCB website at MCAP/. The files have been created so that you can open the form, type in the requested information, save and print/ the completed form. To save and use these forms: 1. Locate and save the appropriate form(s) to your desktop; 2. Open the file and fill in the information using the fields provided; 3. Save the form to your computer and or print/mail the completed form to the attention of the appropriate party. Requirement Online Certification System Registration MCAP Application for Certification Certification Fee MCAP Training Verification Form and Supporting Documentation MCAP Work Experience Verification Form MCAP On-the-Job Supervision Verification Form MCAP Recommendation for Certification Form Available Formats Online only. Online MCAP Application for Certification (form is built into the system), or Hardcopy MCAP Application for Certification (form is downloaded from FCB website) Submit payment online, over the phone ($5 processing fee), or by check/money order. Form is downloaded from FCB website. Online applicants complete and upload the form and supporting documents at the same time as completing the online MCAP Application for Certification. Hardcopy applicants complete and print the form, attach copies of supporting documentation and mail all documents to the FCB. Form is downloaded from FCB website. All applicants complete Part 1 of the form and provide it to the appropriate party for completion. NOTE: Use only one form per employer/supervisor/person. The hours documented on each form will be complied by the FCB. The individual completing the form mails or s the form and any supporting documentation directly to the FCB. MCAP Candidate Guide Page 6 of 30 Effective Date: September 1, 2015

12 Online Certification System Registration All applicants for certification MUST create an account on the FCB s online certification database. You are strongly encouraged to complete this step as soon as possible because there is a 2-business day timeframe between system registration and system approval. To create your account, complete the following steps (screen shots are provided in the following pages): 1. Go to the FCB s website at 2. Select My Account from the top of the homepage. This link will open a new page. 3. Select Register from the top of the new page. This link will open a new page entitled New User Registration. 4. Complete all required fields of information. (First Name, Last Name, Phone, , Confirm , Password, Confirm Password, Contact Preference, Street Number, Street Name, Street Type, Address Type, City, Zip Code) 5. Select Submit at the bottom of the page. You will know that your registration request was successfully submitted when you see this message on the screen: User Successfully Created. You will receive an once your account is approved and activated. 6. The 2-business day clock starts when the FCB receives the registration request. During this time, FCB staff will review and approve the registration request. Upon approval, you will receive a system-generated stating that your account has been approved and that you may access the system using the and password you registered with. IMPORTANT NOTES: It is CRITICAL that you keep track of the and password you entered when creating your account. The system sends all password resets to the address on your account. If your address changes and you can no longer access it, you may be required to re-register. We STRONGLY RECOMMEND that you register with your primary personal contact information instead of your work contact information. DO NOT request a password reset (through the online system) UNTIL you have received your approval . Your and password combination WILL NOT WORK until the FCB has approved your account and you have received the approval . You will access your account to update your contact information, apply for certification and pay fees. It is your responsibility to ensure that the FCB has your current mailing address and address. DO NOT complete multiple New User Registrations. This will lock you out of the system. For additional assistance in electronic submission, please contact our offices at MCAP Candidate Guide Page 7 of 30 Effective Date: September 1, 2015

13 Step 1: MCAP Application Portfolio Your MCAP Application Portfolio consists of a series of mandatory forms and supporting documents. As an applicant, you will submit: MCAP Application for Certification MCAP Training Verification Form and supporting documentation MCAP Certification fee(s) Application Portfolio Examination Process Certification Award The remaining documents are submitted by your college or university, current or former employers, supervisors and other persons with knowledge of your professional background. These forms include: Official transcript MCAP Work Experience Verification Form and supporting documentation, if necessary MCAP On-the-Job Supervision Verification Form MCAP Professional Letter of Recommendation Forms Maintenance and Renewal Who Completes Which Form? Form/Documentation Certified Master s Level Addiction Professional Application Formal Education MCAP Training Verification Form and Supporting Documentation MCAP Work Experience Verification Form MCAP On-the-Job Supervision Experience Verification Form MCAP Recommendation for Certification Form Person to complete and submit forms and/or supporting documentation: The applicant completes and submits the Certified Master s Level Addiction Professional Application online or by hard copy. Official transcripts are required to document post-secondary education/degrees. Official transcripts may only be provided to the FCB by the college/university issuing the degree to the applicant. May only be submitted via the college/university s e-transcript provider or hard-copy mail. The applicant completes and submits the Training Verification Form(s) and all supporting documentation online or by hard copy. The applicant s employer(s) complete and submit the Work Experience Verification Form(s) to the FCB by or in hard copy. The applicant s supervisor(s) complete and submit the Work Experience Verification Form(s) to the FCB by or in hard copy. The individual providing the recommendation completes and submits the Recommendation for Certification Form to the FCB by or in hard copy. MCAP Candidate Guide Page 8 of 30 Effective Date: September 1, 2015

14 MCAP Application for Certification: Online Submission When you apply for the MCAP online, you need to be prepared to complete the application and upload the Training Verification Form and supporting documentation and pay certification fees at one time because you CANNOT start and stop the online application process: you must complete the application process in one sitting. To access the online application, complete the following steps (screen shots are provided in the following pages): 1. Go to the FCB s website at 2. Select My Account from the top of the homepage; this link will open a new page. 3. Select Log On from the top of the new page, which will open the Log On screen. 4. Enter your address and password you provided during the registration process. 5. Successful Log On will open your account in the Citizen Access Portal. 6. Select Apply from the top menu bar, which will open the Apply for Certification screen. 7. In the Type drop down box, select Addiction. 8. In the Classification drop down box, select Master s Level Addiction Professional (MCAP), this will open the MCAP Application. 9. Provide all requested information. 10. Attach your Training Verification Form and Supporting Documentation (see Training Verification Form section of this Guide for details.) 11. Select Submit. 12. Complete the online fee payment process. Tips for Online Application Please print the Certified Master s Level Addiction Professional Candidate Guide and use the forms as worksheets before starting the application process. Gather and scan all supporting documentation to your computer before starting the electronic application process. You will need electronic copies of all training certificates, transcripts or other documentation. You CANNOT start and stop the online application process: you must complete the application process in one sitting. o You complete the Certified Master s Level Addiction Professional Application and submit payment online. MCAP Candidate Guide Page 9 of 30 Effective Date: September 1, 2015

15 o o You upload electronic copies of education and training documentation to the online system. All other mandatory forms are mailed or ed to the FCB by the person completing the form(s) and FCB staff uploads files to the online system. If you pay the certification application fee at the time of application, your certification status will show applicant online NP. If you do not make your payment at the time you complete your online application, your certification status will show applicant online and the FCB will not initiate any review activity until payment is received. If you answered Yes, I have had a felony or second degree misdemeanor charge in my past on the Certified Master s Level Addiction Professional Application, the FCB will contact you for an additional $20 for the criminal background report fee you cannot pay this fee online. Do not forget to contact your college or university and request that an official transcript is submitted to the FCB. The FCB will NOT accept unofficial transcripts or transcripts provided by anyone other than the degree granting institution. For additional assistance in electronic submission, please contact our offices at MCAP Application for Certification: Manual Submission Complete the hard-copy Certified Master s Level Addiction Professional Application form. Mail the completed form and your fee payment (check or money order) to the FCB. Your fee is either: $175 (application fee of $150 and manual application processing fee of $25) $195 (application fee of $150; manual application processing fee of $25; and criminal background report fee of $20) FCB Accept/Deny Criteria The Certified Master s Level Addiction Professional Certification Application will be approved if: All sections are complete; Fees are paid; You agree to follow and/or acknowledge FCB policy statements; Proof that you hold a Master s degree or higher in a related field from an accredited educational institution is received; and Your criminal background is approved. MCAP Candidate Guide Page 10 of 30 Effective Date: September 1, 2015

16 MCAP Application Sections Application Section 1. Demographics/Contact Information Policy Statement Provide all requested information. If information is not available, enter N/A or none. Applicants may not omit social security numbers, primary address, or mailing address. 2. Education Background Provide all requested information for your MOST RECENT RELATED DEGREE only. 3. Certification and/or Licensure Background Provide all requested information. 4. Work History Provide your work history for the last 5 years. Attach additional sheets if necessary; be sure to include your name and all information provided on the application. 5. Recommendations For tracking purposes, you must provide the names of the individuals you are asking to provide a Recommendation for Certification. 6. Background History You are required to disclose your criminal background history and authorize the FCB to conduct random criminal background checks to assure compliance with the FCB Code of Ethical and Professional Conduct. If you have a felony or first degree misdemeanor in your history, you must disclose specified information and provide official documentation showing your release from all court-ordered sanctions. Carefully read the FCB Criminal Background Policy and the FCB Code of Ethics which is posted on the FCB website at to ensure understanding of policy and requirements. 7. Ethical and Professional Conduct 8. International Certification Request (IC&RC) You are required to acknowledge certain standards and your professional responsibility in this section. Before completing this section, you must have the most recent copy of the FCB Code of Ethical and Professional Conduct, which is posted on the FCB website at You are required to indicate your intent to pursue IC&RC ADC certification at the time of MCAP application. If you maintain your MCAP in good standing, you may be eligible to pursue IC&RC ADC certification at a later date.* 9. Assurance and Release You are required to provide specified assurances and releases to the FCB as part of the certification application process. *The FCB is a member-board to the IC&RC. The FCB does not set the ADC credential standards. As long as the IC&RC does not change ADC standards between the date the MCAP is awarded and the IC&RC ADC is sought, you will be eligible to sit for the IC&RC ADC certification exam without documenting additional requirements. MCAP Candidate Guide Page 11 of 30 Effective Date: September 1, 2015

17 Training Verification Form Requirement 350 total clock hours of training divided as follows: 1. Clinical Evaluation: 35 hours 2. Treatment Planning: 30 hours 3. Counseling: 50 hours 4. Case Management and Referral: 15 hours 5. Client, Family and Community Education: 15 hours 6. Documentation: 15 hours 7. Ethical and Professional Responsibilities: 30 hours 8. Supervision: 16 hours 9. Understanding Addiction/Treatment Knowledge: 80 hours 10. Application to Practice/Professional Readiness: 64 hours* *Must include at least 4 hours of HIV-AIDS and 2 hours of Domestic Violence. Content-specific training for initial application purposes DOES NOT have to be delivered by an FCB approved training provider. No more than 100 of the 300 hours may be met through non-accredited online education. Online coursework taken from an accredited college or university does not count against the 100 hour limit. All training must have been completed within the last 10 years, with the exception of college coursework taken from an accredited college or university, which may exceed 10 years. Supporting Documentation Requirements All training hours claimed for certification credit must include supporting documentation. Approved documentation provides the following minimum information: Participant Name Title of course/training/educational event* Event sponsor/provider Delivery date(s) Number of Contact Hours MCAP Candidate Guide Page 12 of 30 Effective Date: September 1, 2015

18 *If the event title does not clearly identify the instructional content, attach an official description of the event, such as an agenda or syllabus. In the absence of complete documentation, contact the training provider and request documentation of all required information on their official letterhead; you may submit these letters as supporting documentation of successful completion of training requirements. If you use college coursework for training credit, you must provide an unofficial or official copy of your transcript and a copy of the course description as published in the course catalogue. How to Calculate Training Hours College coursework is credited at the rate of 45-clock hours per 3-semester hour course. Partial-day, Full-day and Multi-day training events are credited for instructional time only. Breaks are deducted from the total hours claimed. Conferences are credited for break-out session and plenary sessions only. Breaks are deducted from the total hours claimed. Please attach a copy of the conference program to your application. Documentation and Submission Protocol Electronic Submission: A separate Training Verification form has been developed for each training topic. Download the electronic Training Verification Form file, enter all requested information; create an electronic copy of your supporting documentation (in the same order as listed on the Training Verification forms); upload the completed Training Verification Forms and supporting documentation to the system. Hard-copy Submission: A separate Training Verification form has been developed for each training topic. Download the electronic Training Verification Form file, enter all requested information; make copies of all supporting documentation; place supporting documentation behind each Training Verification form in in the same order as listed on the Training Verification form; mail the Training Verification Forms and supporting documentation to the FCB. FCB Accept/Deny Criteria Each training requirement is verified individually and will be approved if: The training documentation includes all required information; The training was completed within the last 10 years (with the exception of college coursework); and There is a clear link between the training event and the content-specific training requirement. MCAP Candidate Guide Page 13 of 30 Effective Date: September 1, 2015

19 Related Work Experience Verification Form Requirement 4,000 hours of experience providing addiction-related services at the level expected of a MCAP. All work experience hours must be directly related to work performed at the professional counseling level. Job experience in the addiction field at the technician level is not eligible to meet the MCAP Related Work Experience requirement. Work experience is documented by the employer on FCB provided forms. If multiple employers need to be contacted to document all hours, provide a separate form to each employer. Work experience must have been gained within the last 10 years. Documentation and Submission Protocol Electronic Submission: All documentation comes from the employer and is uploaded to the system by an FCB Certification Specialist. Hard-copy Submission: 1. Download the electronic Work Experience Verification Form file and complete Part Provide the updated electronic file or a hard copy of the Work Experience Verification Form to your current and/or former employer s personnel officer or designee and ask them to: a. Complete Part 2 of the form and attach an official position description. In the absence of an official position description, a narrative and listing of duties written on agency letterhead may be provided. b. Submit the form and supporting documentation to the FCB at one of the following: The direct address of your assigned certification specialist; OR A stamped envelope, addressed to: Florida Certification Board; Attn: Certification Operations; 1715 S. Gadsden Street; Tallahassee, FL MCAP Candidate Guide Page 14 of 30 Effective Date: September 1, 2015

20 How to Calculate Related Work Experience Hours Full-time work is credited at the rate of 40 hours per week; 1,040 for 6 months; or 2,080 for 1 year. Part-time work is credited on an hour-for-hour basis. FCB Accept/Deny Criteria Related work experience will be approved if:. The Work Experience Form is complete; An official position description or narrative of duties is provided; There is a clear link between the duties performed and the duties expected of a Certified Master s Level Addiction Professional; The form is submitted by the applicant s employer; and Work experience occurred within the last 10 years. MCAP Candidate Guide Page 15 of 30 Effective Date: September 1, 2015

21 On-the-Job Supervision Verification Form Requirement 200 hours of direct supervision of the applicant s performance of addiction-related services. Within the total 200 supervision hours, a minimum of 20 hours of supervision must be completed and documented for each performance domain (Clinical Evaluation; Treatment Planning; Counseling; Case Management and Referral; Client, Family and Community Education; Documentation; Ethical and Professional Responsibilities; and Supervision) On-the-job supervision must have been gained within the last 10 years. On-the-job supervision must have been provided and documented by a qualified supervisor. If multiple supervisors need to be contacted to document all hours, provide a separate form to each supervisor. Definition of a Qualified Supervisor: For MCAP certification purposes, a qualified supervisor is any one of the following: A physician or physician s assistant licensed under Chapters 458 or 459, F.S. A professional licensed under Chapters 490 or 491, F.S. A Psychiatric Advanced Registered Nurse Practitioner (ARNP) licensed under Part 1 of Chapter 464, F.S. and meeting the Board of Nursing requirements for a Psychiatric ARNP designation. A Certified Addiction Professional (CAP) A Certified Master s Level Addiction Professional (MCAP) Credentials must be active, issued by the State of Florida or FCB, and in good standing. A registered intern may not provide on-the-job supervision for certification purposes. Supervision provided by a relative, any person sharing the same household, or any person in a romantic, domestic, or familial relationship with the applicant is not acceptable toward fulfillment of certification requirements. Documentation and Submission Protocol To document the on-the-job supervision provided to the applicant, the qualified supervisor must maintain employer based documentation, as described below. Employer-based documentation: Qualified supervisors must document supervision according to agency protocol. These supervision records are maintained by the employer and are not submitted to the FCB with the form, however, employers are required to maintain supervision records that support the information documented on the form in case of audit. MCAP Candidate Guide Page 16 of 30 Effective Date: September 1, 2015

22 On-the-Job Supervision Verification Form: Each qualified supervisor who provides supervision for certification purposes must complete an On-the-Job Supervision Verification Form. Collectively, the On-the-Job Supervision Verification Forms must document completion of the total on-the-job supervision requirement. Electronic Submission: All documentation comes from the qualified supervisor and is uploaded to the system by an FCB Certification Specialist. Hard-copy Submission: 1. Download the electronic On-the-Job Supervision Verification Form file and complete Part Provide the updated electronic file or a hard copy of the On-the-Job Supervision Verification Form to each qualified supervisor and ask them to: a. Complete Part 2 of the form. b. Submit the form and supporting documentation of Qualified Supervisor status to the FCB at one of the following: The FCB address of [email protected]; OR the direct address of your assigned certification specialist; OR A stamped envelope, addressed to: Florida Certification Board; Attn: Certification Operations; 1715 S. Gadsden Street; Tallahassee, FL How to Calculate On-the-Job Supervision Hours Supervision hours must be reported as documented according to agency protocol. Do not report supervision hours in increments of less than 15-minutes. FCB Accept/Deny Criteria On-the-Job Supervision will be approved if:. The On-the-Job Supervision Verification Form is complete; Supervision was provided by a Qualified Supervisor and documentation is attached. There is a minimum of 20 hours of supervision documented in each performance domain and 200 hours of on-the-job supervision are documented in total. Documentation is submitted directly to the FCB from the qualified supervisor(s). Documented on-the-job supervision occurred within the last 10 years. MCAP Candidate Guide Page 17 of 30 Effective Date: September 1, 2015

23 Recommendation for Certification Form Requirement Three (3) Professional Recommendation s for Certification. For certification purposes, a professional recommendation is provided by an individual who has direct knowledge of the applicant s on-the-job performance as a Master s Level Addiction Professional. While teamwork, experience and work ethic are the types of things discussed, the recommendation should give the FCB an idea of the type of individual applying for the Certified Master s Level Addiction Professional (MCAP) credential. Individuals providing a professional recommendation must be in a non-peer or non-subordinate position to the applicant. Typical individuals eligible to provide a professional recommendation for certification include the applicant s immediate supervisor or any other agency supervisor, trainer, mentor, quality assurance staff, and any other agency management or leadership staff. A Professional Recommendation for Certification may not be provided by a relative, any person sharing the same household, or any person in a romantic, domestic, or familial relationship with the applicant. Documentation and Submission Protocol Electronic Submission: All documentation comes from the individual providing the Recommendation for Certification and is uploaded to the system by an FCB Certification Specialist. Hard-copy Submission: 1. Download the electronic MCAP Professional Recommendation for Certification Form; complete Part 1 of the form; resave the partially completed form to your computer. 2. or print a hard copy of the form, provide it to the individuals you are asking to make the recommendation, and ask that they: a. Complete Part 2 of the form. b. Submit the form and supporting documentation to the FCB at one of the following i. The direct address of your assigned certification specialist; OR ii. A stamped envelope, addressed to: Florida Certification Board; Attn: Certification Operations; 1715 S. Gadsden Street; Tallahassee, FL FCB Accept/Deny Criteria Recommendations for Certification will be approved if: The Recommendation for Certification Form is complete; and The form is submitted to the FCB by an individual qualified to provide the recommendation. MCAP Candidate Guide Page 18 of 30 Effective Date: September 1, 2015

24 Step 2: Examination Process Requirement Earn a passing score (78% or higher) on the Florida Certified Master s Level Addiction Professional (MCAP) exam. The MCAP exam is a 125 item, multiple-choice test. How, when and where is the MCAP Exam administered? HOW: All FCB exams are computer-based, online exams. There are NO paper and pencil exam administrations available. To provide as many testing sites as possible, the FCB has contracted with Schroeder Measurement Technologies (SMT) to administer and score all FCB examinations. Examinations are administered through a division of SMT called ISO-Quality Testing, Inc. (IQT). IQT provides secure, user-friendly, highquality, examination administration around the world. You can find out more information at their websites: and WHEN and WHERE: Each test site sets up its own calendar of the days and times that they are open and available to administer the test. When you are approved to register for the test, you will tell the FCB the month that you want to test. The FCB then pre-registers you with our testing vendor. The testing vendor will send you an with a link that allows you to select the test site and test date and test time that is best for your schedule. Exam Registration Approval, Pre-registration & Registration Process Pre-registration When your MCAP Application Portfolio has been approved, your Certification Specialist will you the Exam Pre-registration Form. The FCB is responsible for the pre-registration process and you are responsible for the registration process. Submit the completed Exam Pre-registration Form and your test fee payment directly to your Certification Specialist, who will complete the pre-registration process. The pre-registration process is complete when you receive an from [email protected] with the subject line: Iso-Quality Testing: Certified Master s Level Addiction Professional. MCAP Candidate Guide Page 19 of 30 Effective Date: September 1, 2015

25 Here is a sample of what your will look like: To complete the exam registration process, follow the directions in the from [email protected] Taking the MCAP Exam When you complete the registration process, you will be provided with an EXAM REGISTRATION RECEIPT that includes the test date, location and other information about exam administration. On the day of testing, you ARE REQUIRED to bring a valid, government issued photo ID and your Candidate Admission Letter to the testing center. We strongly recommend that you read the entire Candidate Admission Letter as you will be held to the IQT testing policies and procedures. The MCAP exam is a 125-item, multiple choice test. You have two hours to take the test. The proctor cannot extend your time. If you need special accommodations, such as additional testing time, please see the SPECIAL ACCOMMODATIONS section of the FCB website. CBT exams begin with a brief tutorial and end with a brief survey. Extra time is allotted to complete the tutorial and survey. A demonstration of the CBT exam format is at Score Reporting The minimum passing score is 78%. This means that you can miss a maximum of 28 questions and pass the exam. You will receive unofficial score results immediately. Your score is official when your Certification Specialist receives the official score from SMT/ISO Quality Testing in approximately 2 to 4 weeks from your exam date. MCAP Candidate Guide Page 20 of 30 Effective Date: September 1, 2015

26 If you do not pass the exam, you will be provided with percentages of correctly answered items in each content domain to better focus future study efforts. For security reasons, you will not be provided with a copy of the examination to review. If you are interested in retaking an exam, you must wait 30 days after your most recent exam attempt. To schedule a retake, contact your assigned Certification Specialist at the FCB at Test scores are valid for a three-year period. Individuals who allow their credential(s) to become inactive and have a test score older than threeyears will be required to retest as part of the reinstatement process. Rescheduling, Cancelling, and Missed Exams CBT exams can only be cancelled or rescheduled 5 days or more PRIOR to your scheduled examination date. Cancelling or rescheduling an exam is done directly through IQT s website at Complete instructions for cancelling or rescheduling an examination are listed below. For technical assistance, please contact IQT toll free at (866) Visit 2. Select Exam Registration. 3. Log in using the username and password provided to you in your pre-registration . If you forgot your password, click the forgot password link and it will be ed to you. 4. Select Florida Certification Board from the dropdown menu and click the Next button. 5. To reschedule an exam, click edit. This will cancel your current exam date and prompt you to immediately select a new date. 6. To cancel an exam, click cancel. Once your exam is cancelled, you can log onto at a later date to select a new examination date. Please note that your designated testing window to take the exam will remain the same. 7. An confirmation will be automatically sent to you when you cancel or reschedule your examination. You are unable to reschedule or cancel an examination less than 5 days PRIOR to your scheduled examination. Exceptions are made only for the following four reasons: 1. Jury duty, 2. Death in immediate family within 14 calendar days of the examination date, 3. Illness or medical complication within 14 calendar days prior to the examination date OR the scheduled examination date, and 4. Military deployment. MCAP Candidate Guide Page 21 of 30 Effective Date: September 1, 2015

27 If one of these four reasons prevents you from testing, you must contact IQT directly and provide sufficient documentation of the event that has occurred. Documentation must be submitted to IQT within 14 calendar days of your missed examination. There will be no additional fee incurred under these circumstances. IQT can be reached toll free at If you fail to show up for your examination at the scheduled time, do not have the proper identification, or your Candidate Admission Letter, you will not be permitted to sit for your exam. You will be considered a No-Show, your examination fees will be forfeited, and you will be required to re-register and pay all fees to the FCB prior to sitting for the exam. Candidates who miss their scheduled examinations must contact the FCB to reschedule the exam. Examination Rules and Security Failure to follow candidate instructions or conduct that result in violation of security or disruption of the administration of an examination may result in dismissal from the examination, voided examination scores, and forfeiture of examination fees. Examples of misconduct include, but are not limited to: Writing on anything other than the authorized scratch paper provided at the administration site Looking at other candidate's examination Discussing examination content before, during, or after administration orally, electronically or in writing with any person or entity Copying or removing examination information from the testing area Use of cellphones or other electronic devices Candidates may not attend the examination only to review or audit test materials. No unauthorized persons will be admitted into the testing area. All examination content is strictly confidential. Candidates may only communicate about the examination, using appropriate forms provided within the examination delivery system. No books, papers, or other reference materials may be taken into the examination room. An area will be provided for storage of such materials. No questions concerning the content of the examination may be asked during the examination period. The candidate should listen carefully to the directions given by the Proctor and read the examination directions carefully. MCAP Candidate Guide Page 22 of 30 Effective Date: September 1, 2015

28 Step 3: Certification Award, Continuing Education & Renewal Certification Award The Certified Master s Level Addiction Professional (MCAP) credential is issued within 10 business days of the FCB s receipt of official passing test score(s). The credential issue date is the day you earned a passing score on the required exam. The MCAP credential is issued for a 12-month period, and will always renew on June 30th of the renewal calendar year. Maintaining a credential in good standing is very important. To further our mission of public safety, the FCB maintains a public-access database allowing verification of an individual s certification status and ethical history. To remain in good standing, certified professionals must: Actively participate in annual continuing education to maintain a current knowledge and skill base. Follow the FCB Code of Ethical and Professional Conduct. Complete the renewal process in a timely manner, every June. Please carefully read this section to ensure you understand maintenance and renewal requirements. Continuing Education Requirement MCAPs must complete 20 hours of continuing education units (CEUs) per year. One CEU is equal to 50 minutes of instruction. Training content must be related to at least one of the MCAP performance domains and CEU hours must be non-repetitive (i.e., the same course cannot be claimed more than one time during each credentialed period, even if the course was taken annually.) FCB Recognized and Approved Continuing Education Providers Continuing education units must be earned from a FCB recognized or approved CEU training provider. Some training providers hold approval from other entities that are recognized by the FCB; other training providers apply for and hold FCB Training Provider Status. The FCB will honor CEUs issued by any of the following providers: 1. College or university coursework offered by institutions holding Federal Department of Education and/or Council of Higher Education Accreditation (CHEA) recognized accreditation. 2. Training providers approved to offer CEUs by other state or national professional licensing or certification boards. MCAP Candidate Guide Page 23 of 30 Effective Date: September 1, 2015

29 3. FCB Approved Education and Training Providers: The FCB will award FCB Education and Training Provider status and a number to approved applicants. A list of approved FCB Education and Training Providers is maintained on our webpage at How to Document Compliance with CEU Requirements The certified professional is responsible for maintaining CEU documentation for a minimum of 3 years, in case of audit. Valid documentation includes certificates of completion, official employer training transcripts, or college/university transcripts. Approved documentation provides the following minimum information: Participant Name Title of course/training/educational event* Event sponsor/provider Delivery date(s) Number of Contact Hours *If the event title does not clearly identify the instructional content, attach an official description of the event, such as an agenda or syllabus. In the absence of complete documentation, contact the training provider and request documentation of all required information on their official letterhead. You may submit these letters as supporting documentation of successful completion of training requirements. If you use college coursework for training credit, you must provide a copy of your transcript and a copy of the course description as published in the course catalogue How to Calculate CEU Hours One CEU is equal to 50 minutes of instruction. College coursework is credited at the rate of 45-clock hours per 3 semester hour course. Partial-day, Full-day and Multi-day training events are credited for instructional time only. Breaks are deducted from the total hours claimed. If the total credit hours are not listed on the certificate, attach a copy of the training agenda. Conferences are credited for break-out session and plenary sessions only. Breaks are deducted from the total hours claimed. Please attach a copy of the conference program to your application. CEU Audit Approximately 3 months prior to the credential s expiration date, the FCB will randomly select 20% of the certified population for a CEU audit to ensure compliance with the CEU requirement. Audited individuals will be notified of such approximately 2 months prior to the credential s expiration date and must submit CEU documentation to the FCB for review and approval PRIOR to the credential expiration date. Please note: payment of renewal fees and non-submission or denial of submitted CEUs may result in the credential being placed on inactive status. MCAP Candidate Guide Page 24 of 30 Effective Date: September 1, 2015

30 Although only audited individuals are required to submit CEU documentation to the FCB as part of the renewal process, all certified professionals must maintain documentation of compliance with CEU requirements for 3 years, in case of future audit. FCB CEU Accept/Deny Criteria CEU documentation will be approved if: The documentation includes all required information; The training was completed between the certification award and expiration dates, and There is a clear link between the training event and the scope of service for a MCAP. Failure to meet these requirements may result in disciplinary or ethical action. Credentials will not be renewed until CEU requirements are satisfied. Credential Renewal The MCAP credential renews every year, on or before June 30th. Depending on the initial certification award date, first time credential holders may be certified for slightly more or less than a standard 12- month period. Credentials earned in June March will renew in June. Credentials earned in April or May will renew the following June. The full 12-month renewal cycle will start after the credential is renewed for the first time. Renewal Notice Process The FCB will send out renewal notices in April and May of the renewal year. Renewal fees must be paid and, if audited, CEU documentation must be approved no later than June 30th of the renewal year. Individuals who DO NOT meet renewal requirements by June 30th may pay the renewal fee, a $50 late fee and must submit CEU (regardless of audit status) no later than July 31st of the renewal year. Individuals who DO NOT meet renewal requirements by August 1st of the renewal year will be automatically placed in inactive status and must complete the FCB Reinstatement Process to recertify. MCAP Candidate Guide Page 25 of 30 Effective Date: September 1, 2015

31 FCB Appeal Process When an applicant is denied certification, questions the results of the application review process, questions examination results, or is subject to an action by the FCB or its agents that he or she deems unjustified, the applicant has the right to an inquiry and/or an appeal. An inquiry is when an applicant requests a written summary from the FCB that explains the reason for the action in question. A letter requesting an inquiry must be made to the FCB s Director of Certification, in writing, within 30 calendar days of notification of FCB decision and/or action. An applicant shall be considered notified within 3 days of the date of the FCB s notification. If the applicant does not agree with the decision and/or rationale of the FCB, he or she may request an appeal. An appeal may be made to the FCB s Director of Certification, in writing, within 30 calendar days of notification of FCB decision and/or action on the applicant s inquiry. An applicant shall be considered notified within 3 days of the date of the FCB s notification. The written appeal will be provided to the appropriate committee of the FCB s Behavioral Health Advisory Council for review and action. The applicant will be notified in writing within 5-business days of the committee s decision. The committee s decision is final and not subject to further appeal. MCAP Mandatory Forms Use this section to preview directions and required forms for certification application. Each form is posted on the FCB website in an editable format. Download, complete and use the editable forms for all hard-copy submission and to complete Part I of each form that you must provide to another person to complete and submit to the FCB in support of your Certification Application. Certified Master s Level Addiction Professional Application (electronic or hard copy) MCAP Training Verification Form (electronic or hard copy) MCAP Work Experience Verification Form (hard copy only) MCAP On-the-Job Supervision Form (hard copy only) MCAP Professional Recommendation Form (hard copy only) MCAP Candidate Guide Page 26 of 30 Effective Date: September 1, 2015

32 This form is to be completed in its entirety by the applicant. Master s Level Addiction Professional Application for Certification Partial, incomplete or illegible applications will be returned to the applicant. All statements provided on this application are subject to verification. False statements, omissions, alterations to the application, failure to supply requested information and/or failure to agree to follow Florida Certification Board (FCB) policies and procedures may be grounds to disqualify an applicant from certification. Section 1: Contact and Demographic Information. Please provide all requested information. Enter None or N/A as appropriate. Last Name First Name Middle/Maiden Name Date of Birth Social Security Number Primary Address Home Phone Cell Phone Home Address Line 1 Home Address Line 2 City State Zip code County Current Employer Current Position Title Employer s Webpage Address Business Phone Work Address Line 1 Work Address Line 2 City State Zip code County Although the following information is not mandatory, it is requested to assist the FCB in its commitment to equal certification opportunity and affirmative action. It is unlawful for an organization to fail to certify or refuse certification to any individual because of race, color, religion, national origin, marital status or handicap.. I prefer NOT to provide the FCB with my voluntary demographic information. Race: Black White Native American/Alaskan Native Asian/Pacific Islander Multi-racial Ethnicity: Hispanic/Latino Non-Hispanic/Latino Gender: Female Male Florida Certification Board (FCB) Effective Date: MCAP Application for Certification

33 Master s Level Addiction Professional Application for Certification Section 2: Education Background. Applicants must hold a minimum of a Master s Degree in a related field. Related degrees are: 1. Counseling, to include Addiction Studies/Counseling; Marriage and Family Counseling; Mental Health Counseling; Pastoral Counseling; Rehabilitation Counseling; Recreational Therapy/Counseling. 2. Psychology, to include Art Therapy; Music Therapy; and Expressive Arts Therapy 3. Social Work 4. Advanced Nurse Practitioner with psychiatric specialty If you believe you have a related degree that is not listed above, please STOP and request an FCB Related Degree Equivalency Review before applying as CERTIFICATION APPLICATION FEES ARE NONREFUNDABLE. Most Recent Related Degree Degree Type: MA/MS/MEd PhD ARNP-Psychiatric Specialty MD/DO Other Degree Field (please select from the list above): Month/Year of Graduation: School Name: School Location: City Is the name on your transcript the same as on your application for certification? If no provide your name as it is listed on your transcript: Have you previously submitted this official transcript to the FCB for another credential? If yes provide the credential name and number: State Yes No Yes No Section 3: Certification and/or Licensure Background. Provide all requested information. Attach additional pages if necessary. 1. Do you currently hold any other professional certification or license? Yes (please complete the following fields) No (skip to the next question) Credential Name Issuing Authority Issue Date Expiration Date Credential Name Issuing Authority Issue Date Expiration Date 2. Have you ever had disciplinary action taken against any former or current professional certification or license, including actions taken against you while in applicant or registered intern status? Yes (please complete the following fields) No (advance to Section 4 of this application) Credential Name Issuing Authority Date of Incident/Allegation: Disposition of Allegation: Allegation Supported Allegation Not Supported Allegation Dismissed Other Description of Incident/Allegation and Outcome(s): Florida Certification Board (FCB) Effective Date: MCAP Application for Certification

34 Master s Level Addiction Professional Application for Certification Section 4: Work History. Please list your employment history for the last five (5) years. Report employment dates in the following format: May 2009 Aug Add additional pages if necessary. Employer: Type of Position (select all that apply): Full-time Part-time Paid Employer Webpage Address: Position Title: Employment Dates: Immediate Supervisor: Describe Duties: Employer: Type of Position (select all that apply): Full-time Part-time Paid Employer Webpage Address: Position Title: Employment Dates: Immediate Supervisor: Describe Duties: Employer: Type of Position (select all that apply): Full-time Part-time Paid Employer Webpage Address: Position Title: Employment Dates: Immediate Supervisor: Describe Duties: Florida Certification Board (FCB) Effective Date: MCAP Application for Certification

35 Master s Level Addiction Professional Application for Certification Section 5: Recommendations. You are required to have three (3) professional letters of recommendation as part of your FCB application file. Please carefully read the Candidate Guide for Application for full requirements. A specific form is used for this the Recommendation for Certification Form. These are to be completed by persons (non-relatives only) who have direct professional knowledge of your work, skills and character. It is expected that you have given the Recommendation for Certification Form to specific people who will complete the form and submit it to the FCB via mail, or fax. For tracking purposes, it is important that we have the names of the persons who will be submitting the forms in support of your application for certification. Please list your anticipated references below. Should a reference change, please contact the FCB to update your application file. Name: Name: Section 6: Background History Part A. As a condition of my candidacy for certification with the Florida Certification Board (FCB), I understand that the FCB will conduct a criminal background check. I understand that once certified I may be selected for random audit to assure compliance with the FCB Code of Ethics. Yes No By checking the affirmative box below, I authorize the FCB and/or any other company authorized by the FCB to access such information as may be necessary to conduct a criminal background check. Yes No I release from liability all persons and entities supplying such information. I indemnify the Florida Certification Board and/or any other company authorized by the FCB against any liability which may result from making such requests. Yes No Section 6 Background History Part B. Have you ever been convicted, pled nolo contendere, or had an adjudication of guilt withheld for any crime which is a felony or 1 st degree misdemeanor? yes no If you answered yes, provide the following information for each charge. Attach additional pages as necessary. Charge: Date and Location Charge Took Place: Disposition of Charge: guilty not-guilty dismissed other Sanctions Applied: Date of Release from Sanctions: Description of Incident/Charge(s): Florida Certification Board (FCB) Effective Date: MCAP Application for Certification

36 Master s Level Addiction Professional Application for Certification Section 7: Ethical and Professional Conduct. You are required to acknowledge certain standards and your professional responsibility in this section. Before completing this section, you must have the most recent copy of the FCB Code of Ethics, which is posted on the FCB website at By checking the acknowledgement box below, I affirm that I understand that I am required to follow the professional standards of conduct detailed in the FCB Code of Ethics. I also affirm that I understand that the FCB Code of Ethics applies to both certification applicants and certified individuals. I acknowledge. I do not acknowledge. By checking the acknowledgement box below, I affirm that I have received a copy of the FCB Code of Ethics and will be responsible for obtaining all future amendments and modifications thereto. I acknowledge. I do not acknowledge. By checking the acknowledgement box below, I further affirm that I have read and understand all of my obligations, duties, and responsibilities under each principle and provision of the FCB Code of Ethics. I will read and understand all future amendments and modifications to the FCB Code of Ethics. I acknowledge. I do not acknowledge. Signature Section 8: International Certification Request (IC&RC). Certified Master s Level Addiction Professional (MCAP) applicants are eligible to earn IC&RC s Alcohol and Drug Counselor (ADC) credential. The minimum standards required for IC&RC ADC certification are met when the applicant has earned the MCAP credential AND has earned a passing score on the IC&RC ADC exam. Note: Applicants approved to take the MCAP exam are also approved to take the IC&RC ADC exam. Applicants do not have to hold the MCAP credential prior to sitting for the IC&RC ADC exam; however, the ADC credential will not be awarded until the MCAP credential is earned. Date I am seeking IC&RC ADC certification at the same time I am seeking the MCAP credential. I am not seeking IC&RC ADC certification at the same time I am seeking the MCAP credential. I understand that I can request IC&RC ADC certification at a later date if I maintain my FCB-eligible credential(s). Section 9: Assurance and Release. I give my permission to the Florida Certification Board (FCB) and its staff to investigate my background as it relates to statements contained in this application. I understand that intentionally false or misleading statements or intentional omission shall result in the denial or revocation of certification. I consent to the release of information contained in my application, certification record, or other pertinent data submitted to or collected by the FCB to officers, staff, and members of the Board of Directors and it s Advisory Boards, Councils and review committees. I further agree to hold the FCB, its board members, employees and examiners free from any civil liability for damages for complaints by reason for any action that is within the scope of the performance of their duties which they may take in connection with this application and subsequent examinations and/or failure of the FCB to issue certification. I hereby affirm that the information provided for this application is correct and that I believe that I am qualified for the level of certification for which I am applying. I acknowledge. I do not acknowledge. Signature Date Florida Certification Board (FCB) Effective Date: MCAP Application for Certification

37 Important Information: Master s Level Addiction Professional Application for Certification 1. Apply On-Line from the FCB website { OR mail your completed form (plus a $25 data entry fee) to the Florida Certification Board: Florida Certification Board Attn: Certification Operations 1715 South Gadsden Street Tallahassee, FL Eligible college or university transcripts are issued by institutions accredited by accreditation bodies recognized by the United States Department of Education and/or the Council on Higher Education Accreditation (CHEA). The institution must have been accredited at the time of award for the degree to be valid for certification purposes. 3. You must provide the FCB with an official transcript of your college or university degree. Post-secondary documentation must be provided to the FCB only by the institution issuing the transcript or degree to the applicant. The FCB will NOT accept unofficial transcripts or transcripts provided by anyone other than the degree granting institution. Official transcripts may only be submitted via hard-copy mail or the institutions e- transcript provider. Your application will not be approved without your official transcript on file with the FCB. 4. You MUST hold a degree in a related field. Related fields are: Counseling, to include: Addiction Studies/Counseling Marriage and Family Counseling Mental Health Counseling Pastoral Counseling Rehabilitation Counseling Recreational Therapy/Counseling Psychology, to include: Art Therapy Music Therapy Expressive Arts Therapy Social Work Advanced Nurse Practitioner with psychiatric specialty If you believe you have a related degree that is not listed above, please STOP and request an FCB Related Degree Equivalency Review before applying as CERTIFICATION APPLICATION FEES ARE NONREFUNDABLE. The FCB Related Degree Equivalency Review policy is maintained on the FCB website at Florida Certification Board (FCB) Effective Date: MCAP Application for Certification

38 Master s Level Addiction Professional Training Verification Form Requirement: MCAP applicants must complete and document a minimum of 350 hours of training, with a minimum number of training hours in each performance domain as follows: 1. Clinical Evaluation: 35 hours 2. Treatment Planning: 30 hours 3. Counseling: 50 hours 4. Case Management and Referral: 15 hours 5. Client, Family and Community Education: 15 hours 6. Documentation: 15 hours 7. Ethical and Professional Responsibilities: 30 hours 8. Supervision: 16 hours 9. Understanding Addiction/Treatment Knowledge: 80 hours 10. Application to Practice/Professional Readiness: 64 hours (must include at least 4 hours of HIV-AIDS and 2 hours of Domestic Violence) MCAP applicants with a non-related degree may have no more than 100 of the 350 hours of required training satisfied through on-line, self-paced delivery methods. All remaining hours must be satisfied through traditional face-to-face training, on-line facilitated training, or on-line courses delivered by accredited colleges or universities. Training hours must be non-repetitive (i.e., the same course cannot be claimed more than one time even if the course was taken multiple times) and all training must have been completed with the last 10 years with the exception of college/university courses, which may exceed the 10 year timeframe. Content-specific training for initial application purposes DOES NOT have to be delivered by an FCB approved training provider. How to Document: Electronic Submission: The applicant completes all required fields of data on the form and uploads the completed form and copies of supporting documentation to the system. Hard-copy Submission: The applicant completes all required fields of data on the form, attaches copies of eligible training documentation (in the same order as listed on the form) and mails all documents to the FCB. Training documentation must provide the following information: Applicant s Name Title of course/training/educational event* Event sponsor/provider Delivery date(s) Number of Contact Hours *If the event title does not clearly identify the instructional content, please attach an official description of the event, such as an agenda or syllabus. If training certificates do not include all required information, contact the training provider and request the additional information on their official letterhead: include these letters with your training documentation. If you use college coursework for training credit, you must provide documentation for each entry as follows: (1) Make a copy of your transcript for each course you are claiming. (2) Highlight the course on the transcript that you are claiming for training credit. (3) Print out the course description published by the educational institution. (4) Place the transcript copy and the course description in the same order as the courses are listed on your training verification forms. Florida Certification Board (FCB) Training Verification Form

39 Master s Level Addiction Professional Training Verification Form (1 of 10) Training Topic: Clinical Evaluation Training Requirement: Minimum of 35 hours of training in topics directly related to Clinical Evaluation. Title of Training Training Provider Date of Training Training Hours Awarded ASAM Placement Criteria Florida Council on Community Mental Health Training Report and Documentation Example Type of Documentation Attached Conference Brochure Training Report and Documentation Example Title of Training Training Provider Date of Training Training Hours Awarded Type of Documentation Attached FCB Use Only FCB Use Only Florida Certification Board (FCB) Effective Date: MCAP Training Verification Form

40 Master s Level Addiction Professional Training Verification Form (2 of 10) Training Topic: Treatment Planning Training Requirement: Minimum of 30 hours of training in topics directly related to Treatment Planning. Title of Training Training Provider Date of Training Training Hours Awarded Training Report and Documentation Example Type of Documentation Attached Stages of Change Community Connections, Inc Certificate of Completion Training Report and Documentation Example Title of Training Training Provider Date of Training Training Hours Awarded Type of Documentation Attached FCB Use Only FCB Use Only Florida Certification Board (FCB) Effective Date: MCAP Training Verification Form

41 Master s Level Addiction Professional Training Verification Form (3 of 10) Training Topic: Counseling Training Requirement: Minimum of 50 hours of training in topics directly related to Counseling. Title of Training Training Provider Date of Training Training Hours Awarded Training Report and Documentation Example Type of Documentation Attached Crisis Intervention Woodland Behavioral Health Certificate of Completion Training Report and Documentation Example Title of Training Training Provider Date of Training Training Hours Awarded Type of Documentation Attached FCB Use Only FCB Use Only Florida Certification Board (FCB) Effective Date: MCAP Training Verification Form

42 Master s Level Addiction Professional Training Verification Form (4 of 10) Training Topic: Case Management and Referral Training Requirement: Minimum of 15 hours of training in topics directly related to Case Management and Referral. Title of Training Training Provider Date of Training Training Hours Awarded Methods for Effective Referrals Training Report and Documentation Example FADAA Annual Conference Training Report and Documentation Example Title of Training Training Provider Date of Training Training Hours Awarded Type of Documentation Attached Conference Certificate of Attendance and Conference Brochure Type of Documentation Attached FCB Use Only FCB Use Only Florida Certification Board (FCB) Effective Date: MCAP Training Verification Form

43 Master s Level Addiction Professional Training Verification Form (5 of 10) Training Topic: Client, Family and Community Education Training Requirement: Minimum of 15 hours of training in topics directly related to Client, Family and Community Education. Title of Training Training Provider Date of Training Training Hours Awarded Adult Learning Principles Training Report and Documentation Example Florida State University Fall Transcript Training Report and Documentation Example Title of Training Training Provider Date of Training Training Hours Awarded Type of Documentation Attached Type of Documentation Attached FCB Use Only FCB Use Only Florida Certification Board (FCB) Effective Date: MCAP Training Verification Form

44 Master s Level Addiction Professional Training Verification Form (6 of 10) Training Topic: Documentation Training Requirement: Minimum of 15 hours of training in topics directly related to Documentation. Title of Training Training Provider Date of Training Training Hours Awarded Clinical Documentation Training Report and Documentation Example Type of Documentation Attached Addiction Training, Inc Certificate of Completion Training Report and Documentation Example Title of Training Training Provider Date of Training Training Hours Awarded Type of Documentation Attached FCB Use Only FCB Use Only Florida Certification Board (FCB) Effective Date: MCAP Training Verification Form

45 Master s Level Addiction Professional Training Verification Form (7 of 10) Training Topic: Ethical and Professional Responsibilities Training Requirement: Minimum of 30 hours of training in topics directly related to Ethical and Professional Responsibilities. Title of Training Training Provider Date of Training Training Hours Awarded HIPAA & Confidentiality Training Report and Documentation Example Type of Documentation Attached CMS Certificate of Completion Training Report and Documentation Example Title of Training Training Provider Date of Training Training Hours Awarded Type of Documentation Attached FCB Use Only FCB Use Only FCB Use Only Florida Certification Board (FCB) Effective Date: MCAP Training Verification Form

46 Master s Level Addiction Professional Training Verification Form (8 of 10) Training Topic: Supervision Training Requirement: Minimum of 16 hours of training in topics directly related to Supervision. Title of Training Training Provider Date of Training Training Hours Awarded Clinical Supervision Basics Training Report and Documentation Example Type of Documentation Attached CMS Certificate of Completion Training Report and Documentation Example Title of Training Training Provider Date of Training Training Hours Awarded Type of Documentation Attached FCB Use Only FCB Use Only FCB Use Only Florida Certification Board (FCB) Effective Date: MCAP Training Verification Form

47 Master s Level Addiction Professional Training Verification Form (9 of 10) Training Topic: Understanding Addiction/Treatment Knowledge Training Requirement: Minimum of 80 hours of training in topics directly related to Understanding Addiction/Treatment Knowledge. Title of Training Training Provider Date of Training Training Hours Awarded History of Addiction Treatment Training Report and Documentation Example Florida State University Spring Transcript Training Report and Documentation Example Title of Training Training Provider Date of Training Training Hours Awarded Type of Documentation Attached Type of Documentation Attached FCB Use Only FCB Use Only FCB Use Only Florida Certification Board (FCB) Effective Date: MCAP Training Verification Form

48 Master s Level Addiction Professional Training Verification Form (10 of 10) Training Topic: Application to Practice/Professional Readiness Training Requirement: Minimum of 64* hours of training in topics directly related to Application to Practice/Professional Readiness. *must include at least 4 hours of HIV-AIDS and 2 hours of Domestic Violence Title of Training Training Provider Date of Training Training Hours Awarded Training Report and Documentation Example Type of Documentation Attached Care for the Caregiver Illuminate Consulting Certificate of Completion Training Report and Documentation Example Title of Training Training Provider Date of Training Training Hours Awarded Type of Documentation Attached FCB Use Only FCB Use Only FCB Use Only Florida Certification Board (FCB) Effective Date: MCAP Training Verification Form

49 Directions Master s Level Addiction Professional Work Experience Verification Form Thank you for taking the time to assist the applicant named above to verify and document his or her related work experience in pursuit of the Certified Master s Level Addiction Professional (MCAP) designation. Please carefully read the Description of a Certified Master s Level Addiction Professional and the Related Work Experience Requirement as listed below. If you have any question as to whether or not specific duties or tasks are eligible to meet Certified Master s Level Addiction Professional Related Work Experience Requirements, please contact our offices directly at To document the applicant s related work experience you must complete this form in its entirety and attach supporting documentation describing the duties and tasks performed by the applicant, such as a position description. In the absence of an official position description, a narrative and listing of duties written on agency letterhead may be provided. Please do not ask the applicant to complete any part of the form, except Part 1. It is FCB policy that this form is completed by the applicant s employer s personnel officer or designee only. Upon completion, please submit the form and any supporting documentation to the FCB at one of the following: Mail: Florida Certification Board Attn: Certification Operations 1715 South Gadsden Street Tallahassee, FL [email protected] Subject Line: Professional Recommendation (applicant name) If the FCB has assigned a certification specialist to the applicant, please use that person s address in lieu of the admin_assist for document submission. Description of a Certified Master s Level Addiction Professional (MCAP) A Certified Master s Level Addiction Professional (MCAP) designation is a professional substance abuse credential for those persons who have demonstrated competency in the performance domains of Clinical Evaluation; Treatment Planning; Counseling; Case Management and Referral; Client, Family and Community Education; Documentation; Ethical and Professional Responsibilities; and Supervision. Individuals holding the MCAP are recognized/hold the practice rights of a qualified professional per Chapter 397, F.S. Related Work Experience Requirement 4,000 hours of direct experience performing addiction-related services at the level expected of a MCAP. All experience must be paid, work experience at the level expected of a master s level addiction professional. Volunteer experience or experience spent participating in treatment is not eligible for certification purposes. Experience providing services at the technician level is not eligible for certification purposes. All experience must have been gained within the last 10 years. Florida Certification Board (FCB) Effective Date: MCAP Work Experience Verification Form

50 Master s Level Addiction Professional Work Experience Verification Form Part 1: To be completed by the applicant prior to providing to the employer for completion. Applicant Information. Please list your employment history for which you are requesting credit for certification and verification by your employer. Report employment dates in the following format: May 2009 Aug Use a separate form for each position and/or employer. Applicant Name: Employer: Type of Position (select all that apply): Full-time Part-time Position Title: Employment Dates: Immediate Supervisor: Part 2: To be completed by the personnel officer or designee only. Section A: Verifier s Information Last Name First Name Title Employer Employer Webpage Address Business Phone Work Address Line 1 Work Address Line 2 City State Zip code County Section B: Experience Attestation I have read and understand the on-the-job experience requirements for Master s Level Addiction Professional (MCAP) certification. The following information can be verified by employment records maintained by the agency. Applicant s Position Description Attached? Yes No* *If no, please attach a written description of the applicant s duties on agency letterhead. Applicant s Dates of Employment: Type of Position (select all that apply): Full-time Part-time Average number of hours per week providing related services: By my signature, I attest that the above material is true to the best of my knowledge. Signature Date Florida Certification Board (FCB) Effective Date: MCAP Work Experience Verification Form

51 Master s Level Addiction Professional On-the-Job Supervision Verification Form Directions Thank you for taking the time to document the on-the-job supervision you provided to the applicant named in Part 1 of this form. Your documentation directly assists the candidate pursuit of the Certified Master s Level Addiction Professional (MCAP) designation. Please carefully read the Definition of a Qualified Supervisor, Description of a Certified Master s Level Addiction Professional and the On-the-Job Supervision Requirement as listed below. If you have any question as to whether or not specific duties or tasks are eligible to meet MCAP On-the-Job Supervision Requirements, please contact our offices directly at To document the on-the-job supervision you provided the applicant, you must maintain employer based documentation, as described below, and you must complete this form in its entirety. Employer-based documentation: Qualified supervisors must document supervision according to agency protocol. These supervision records are maintained by the employer and are not submitted to the FCB with the On-the-Job Supervision Verification Form(s). Employers are required to maintain supervision records that support the information documented on the form in case of audit. On-the-Job Supervision Verification Form: Each qualified supervisor who provides supervision for certification purposes must complete an On-the-Job Supervision Verification Form. Collectively, the forms must document completion of the total On-the-job supervision requirement. Each On-the-Job Supervision Verification Form must be completed by the individual providing supervision. Please do not ask the applicant to complete any part of the form, except Part 1. Upon completion, please submit the form and supporting documentation directly to the FCB via mail or the FCB will not accept On-the-Job Supervision documentation completed and/or submitted in part or whole by the applicant. Mail: Florida Certification Board Attn: Certification Operations 1715 South Gadsden Street Tallahassee, FL [email protected] Subject Line: On-the-Job Supervision Verification (applicant name) If the FCB has assigned a certification specialist to the applicant, please use that person s address in lieu of the admin_assist for document submission. Definition of a Qualified Supervisor: For certification purposes, a qualified supervisor is any one of the following: A physician or physician s assistant licensed under Chapters 458 or 459, F.S. A professional licensed under Chapters 490 or 491, F.S. A Psychiatric Advanced Registered Nurse Practitioner (ARNP) licensed under Part 1 of Chapter 464, F.S. and meeting the Board of Nursing requirements for a Psychiatric ARNP designation. A Certified Master s Level Addiction Professional (MCAP). Credentials must be active, issued by the State of Florida or FCB, and in good standing. A registered intern may not provide on-the-job supervision for certification purposes. Supervisors MUST attach a copy of their current license or MCAP credential to document eligibility to provide supervision for certification purposes. Supervision provided by a relative, any person sharing the same household, or any person in a romantic, domestic, or familial relationship with the applicant is not acceptable toward fulfillment of certification requirements. Florida Certification Board (FCB) Effective Date: MCAP On-the-Job Supervision Verification Form

52 Master s Level Addiction Professional On-the-Job Supervision Verification Form Description of a Certified Master s Level Addiction Professional (MCAP) A Certified Master s Level Addiction Professional (MCAP) designation is a professional substance abuse credential for those persons who have demonstrated competency in the performance domains of Clinical Evaluation; Treatment Planning; Counseling; Case Management and Referral; Client, Family and Community Education; Documentation; Ethical and Professional Responsibilities; and Supervision. Individuals holding the MCAP are recognized/hold the practice rights of a qualified professional per Chapter 397, F.S. On-The-Job Supervision Requirements 200 hours of direct supervision of the applicant s performance of addiction-related services at the level expected of a MCAP. A minimum of 20 hours of supervision must be provided and documented for each performance domain. All on-the-job supervision must have been completed within the last 10 years. Performance Domains: Clinical Evaluation: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks such as intake, orientation, screening and assessment(s) to determine appropriateness for placement and/or develop diagnostic impressions and treatment recommendations. Treatment Planning: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks such as developing and/or updating treatment plans, including mutually agreed upon needs, goals, measurable objectives, treatment methods and discharge criteria. Counseling: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she provides individual and/or group counseling to clients and family members, and performs counseling-related services such as relapse prevention and recovery support. Case Management and Referral: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks directly related to ensuring that client needs that cannot be met in the current treatment setting are addressed with other community resources in a manner that ensures ongoing continuity of care. Client, Family and Community Education: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks such as developing and delivering education and training on health and high-risk behaviors associated with substance abuse, the continuum of care, medication-assisted treatment and other related topics. Documentation: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks such as documenting clinical treatment, writing reports and maintaining client records. Ethical and Professional Responsibilities: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks across all domains in a manner that follows generally accepted legal, ethical, and professional standards. Supervision: Supervision in the domain is directly related to observing and providing feedback to the applicant as he or she performs tasks related to supervising other professionals and para-professionals in the performance of addiction-related treatment services. Florida Certification Board (FCB) Effective Date: MCAP On-the-Job Supervision Verification Form

53 Master s Level Addiction Professional On-the-Job Supervision Verification Form Part 1: To be completed by the applicant prior to providing to the qualified supervisor for completion. Applicant Information. Please list the position you held for which you are requesting documentation of on-the-job supervision by a qualified supervisor. Report employment dates in the following format: May 2009 Aug Use a separate form for each qualified supervisor documenting on-the-job supervision. Name: Employer: Type of Position (select all that apply): Full-time Part-time Position Title: Employment Dates: Immediate Supervisor: Part 2: To be completed by the applicant s qualified supervisor only. Section A: Qualified Supervisor Contact Information Last Name First Name Title Employer Employer Webpage Address Business Phone Work Address Line 1 Work Address Line 2 City State Zip code Section B: Supervision Attestation I am a qualified supervisor because I am: County A physician or physician s assistant licensed under Chapters 458 or 459, F.S. A professional licensed under Chapters 490 or 491, F.S. A Psychiatric Advanced Registered Nurse Practitioner (ARNP) licensed under Part 1 of Chapter 464, F.S. and meeting the Board of Nursing requirements for a Psychiatric ARNP designation. A Certified Master s Level Addiction Professional (MCAP) Qualified supervisors MUST attach a copy of their current license or MCAP credential to document eligibility to provide supervision for certification purposes. Florida Certification Board (FCB) Effective Date: MCAP On-the-Job Supervision Verification Form

54 Section B: Experience Attestation Master s Level Addiction Professional On-the-Job Supervision Verification Form I have read and understand the on-the-job supervision requirements for Master s Level Addiction Professional (MCAP) certification. I provided the following on-the-job supervision to the applicant and maintain supervision records supporting my attestation according to agency protocol. I consent to an audit of such records if requested. I provided on-the-job supervision of the applicant as he or she performed addiction-related duties at the level expected of a MCAP. Yes* No *If yes, how many total hours of on-the-job supervision have you provided? Allocated total hours of on-the-job supervision across performance domains. Clinical Evaluation: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks such as intake, orientation, screening and assessment(s) to determine appropriateness for placement and/or develop diagnostic impressions and treatment recommendations. Treatment Planning: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks such as developing and/or updating treatment plans, including needs, goals, measurable objectives, treatment methods and discharge criteria. Counseling: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she provides individual and/or group counseling to clients and family members, and performs counseling-related services such as relapse prevention and recovery support. Case Management and Referral: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks directly related to ensuring that client needs that cannot be met in the current treatment setting are addressed with other community resources in a manner that ensures ongoing continuity of care. Documentation: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks such as documenting clinical treatment, writing reports and maintaining client records. Client, Family and Community Education: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks such as developing and delivering education and training on health and high-risk behaviors associated with substance abuse, the continuum of care, medication-assisted treatment and other related topics. Ethical and Professional Responsibilities: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks across all domains in a manner that follows generally accepted legal, ethical, and professional standards. Supervision: Supervision in this domain is directly related to observing and providing feedback to the applicant as he or she performs tasks related to supervising other professionals and para-professionals in the performance of addiction-related treatment services. Type of Position Supervised (check all that apply): Full-time Part-time Time period during which supervision was provided: As a qualified supervisor, do you have any concerns about the applicant s ability to competently perform as a Certified Master s Level Addiction Professional? Yes* No *If yes, the FCB will contact you for additional information, which may result in non-acceptance of your on-the-job supervision to meet certification requirements. By my signature, I attest that the above material is true to the best of my knowledge. Qualified Supervisor s Signature Date Florida Certification Board (FCB) Effective Date: MCAP On-the-Job Supervision Verification Form

55 Directions Master s Level Addiction Professional Professional Recommendation for Certification Form Thank you for taking the time to provide a Professional Recommendation for Certification for the applicant named in Part 1 of this form. Your feedback is a critical component of the application process and directly assists the candidate s pursuit of the Certified Master s Level Addiction Professional (MCAP) designation. Please carefully read the Definition of a Professional Recommendation and the Description of a Certified Master s Level Addiction Professional. Based on your relationship and direct experiences with the applicant, carefully consider his or her appropriateness for the role. If you have any question as to the qualifications, scope of service and expectations of a Certified Master s Level Addiction Professional (MCAP), please contact our offices directly at This Professional Recommendation for Certification Form must be completed by the individual providing the recommendation. Please do not ask the applicant to complete any part of the form, except Part 1. It is FCB policy that this form is completed by the individual providing the applicant s recommendation only. Upon completion, please submit the form and any supporting documentation to the FCB at one of the following: Mail: Florida Certification Board Attn: Certification Operations 1715 South Gadsden Street Tallahassee, FL [email protected] Subject Line: Professional Recommendation (applicant name) If the FCB has assigned a certification specialist to the applicant, please use that person s address in lieu of the admin_assist for document submission. Definition of a Professional Recommendation: For certification purposes, a professional recommendation is provided by an individual who has direct knowledge of the applicant s on-the-job performance as an addiction professional. The professional recommendation should discuss the applicant s work performance as it relates to the role and expectations of a Certified Master s Level Addiction Professional (MCAP). While teamwork, experience and work ethic are the types of things discussed, the recommendation should give the FCB an idea of the type of individual applying for certification as an MCAP. Individuals providing a professional recommendation must be in a non-peer or non-subordinate position to the applicant. Typical individual s eligible to provide a Professional Recommendation for Certification include the applicant s immediate supervisor or any other agency supervisor, trainers, mentors, quality assurance staff, and any other agency management or leadership staff. A Professional Recommendation for Certification may not be provided by a relative, any person sharing the same household, or any person in a romantic, domestic, or familial relationship with the applicant. Description of a Certified Master s Level Addiction Professional (MCAP) A Certified Master s Level Addiction Professional (MCAP) designation is a professional substance abuse credential for those persons who have demonstrated competency in the performance domains of Clinical Evaluation; Treatment Planning; Counseling; Case Management and Referral; Client, Family and Community Education; Documentation; Ethical and Professional Responsibilities and Supervision. Individuals holding the MCAP are recognized/hold the practice rights of a qualified professional per Chapter 397, F.S. Florida Certification Board (FCB) Effective date: MCAP Professional Recommendation Form

56 Master s Level Addiction Professional Professional Recommendation for Certification Form Part 1: To be completed by the applicant before giving to the individual providing the Professional Recommendation for Certification as an Addiction Professional (MCAP). Applicant Information. For tracking purposes, it is important that we have your name and the name of the person who will be submitting this Professional Recommendation for Certification Form in support of your application for certification. Please list your name and the name of the individual completing this form as you stated on your Application for Certification. Use a separate form for each individual providing a professional recommendation for certification. Your name: address of your certification specialist at FCB: Name of individual providing the recommendation: Part 2: To be completed by the individual providing the applicant with a Professional Recommendation for Certification as an Addiction Professional. Section A: Contact Information. Please write none or N/A as necessary. Last Name First Name home cell work Primary Address Primary Phone Number Phone Type Contact Address Line 1 City State Zip code County Title Employer Employer Webpage Address Business Phone Section B: Nature of Relationship with Applicant for Certification. Attach additional pages if necessary. Please describe the nature of your relationship with the applicant, including how you are eligible to provide the applicant with a Professional Recommendation for Certification as a Master s Level Addiction Professional (MCAP). Florida Certification Board (FCB) Effective date: MCAP Professional Recommendation Form

57 Master s Level Addiction Professional Professional Recommendation for Certification Form Section C: Recommendation. Attach additional pages if necessary. Please describe why you believe the applicant would be successful in the role of a Certified Master s Level Addiction Professional (MCAP). Please include specific examples of incidents where you observed the applicant successfully demonstrating skills expected of an MCAP. Section D: Attestation. I hereby affirm that I have been in a firsthand position to observe the applicant listed in Part 1 of this form perform addiction-related services at the level expected of a MCAP. I affirm. I do not affirm. I affirm that all of the information that I have provided on this form and any provided attachments is true, to the best of my knowledge. I affirm. I do not affirm. I affirm that I recommend the applicant listed in Part 1 of this form for certification as a Certified Master s Level Addiction Professional (MCAP). I affirm. I do not affirm. Signature Date Florida Certification Board (FCB) Effective date: MCAP Professional Recommendation Form

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