Board Certified Assistant Behavior Analyst work Evaluation Form ver. 4/14 Behavior Analyst Certification Board, Inc. Application for work Evaluation Board Certified Assistant Behavior Analyst (BCBA ) Level 1. Review the Become Certified section of the BACB website at www.bacb.com to ensure that you have the CURRENT fees, are submitting the CURRENT version of this application, and are submitting the correct application for the LEVEL of certification you will ultimately pursue; 2. Review the Application FAQs (Frequently Asked Questions), Exam Information page and Exam Administrations page in the Becoming Certified section of www.bacb.com; 3. Complete the required sections of the Application Form (do not include application policies, instructions or samples) 4. Submit the required documentation of your coursework only (degree & experience information will not be reviewed with a coursework evaluation); 5. Submit the proper current fees (BACB fees are not refundable); 6. Do not tape or staple any materials together; and 7. Maintain a copy of the entire application packet for your records. Once you submit an application packet to the BACB, it becomes the property of the BACB and will not be returned to you. 8. Ensure you submit all of the necessary course content documentation with your initial submission. The BACB will evaluate your coursework based on your initial submission. We will evaluate, if necessary, one set of revised documentation based on our initial determination. The BACB will assess the evaluation fee again if you wish to submit repeated revisions or additional documentation beyond the first revision. FEES US DOLLARS work Evaluation $100.00 All fees must be paid by credit card, personal check, money order or cashier s check in United States currency and made out to the Behavior Analyst Certification Board. Application fees are not refundable. Your application must be mailed to: BACB work Evaluations 8051 Shaffer Parkway Littleton, CO 80127 If you have any questions while completing your application, please contact us at applications@bacb.com or 720-438-4321. You should mail your application by a verifiable method of delivery that includes tracking and delivery confirmation.. The BACB will respond to your application when it is processed. However, we receive a large volume of mail and cannot confirm receipt of individual packages via telephone or email. The BACB requires original signatures on paper applications or online submission. The BACB will not accept applications that are sent by fax or e-mail. BACB certification provides standards for behavior analysts practicing in the United States and worldwide. We seek to include certificants from throughout the world in our job analysis updates to help ensure that our standards are international in scope. However, the BACB does not assure or guarantee consistency with the standards (educational content, training, and laws) for any country, province or region outside of the United States. APPLICATION POLICIES & GUIDELINES Page 1 of 10
Board Certified Assistant Behavior Analyst work Evaluation Form ver. 4/14 BACB coursework evaluation applications are accepted on a continuous basis. work evaluations are intended to provide preliminary determinations on the coursework portion of the BACB s eligibility requirements only. Other requirements required for examination eligibility, such as degree and experience, will not be reviewed as part of a coursework evaluation application. work evaluations are available to potential applicants, subject to the terms and conditions of the Mandatory Certification Processing Agreement included in all applications for BCBA and BCaBA certification. The BACB reserves the right to modify its rules at any time. It is the responsibility of individuals making a request to remain informed of current BACB requirements. If you have not yet applied for certification, any BACB determination regarding your coursework is subject to final determination upon submission of your full certification application to the BACB. Full requirements for BACB exam eligibility are described in detail in the Becoming Certified section of www.bacb.com. Applications are processed in the order in which they are received. The BACB cannot guarantee that your application will be reviewed by a specific date. If you would like your evaluation completed prior to a specific date, such as a university registration deadline, it is your responsibility to ensure that your application is complete and received by the BACB well in advance of your deadline. You should allow at least 45 days for processing beyond the date your application is received. Checks included with applications are typically deposited right away. Your check will probably be deposited before your application is reviewed. If your check has cleared your bank, it is a likely indication that your application has been received. Email is the BACB s primary communication mode with applicants. If additional materials are needed to review your application, we will notify you via email as soon as possible. Checking and responding to your email frequently can expedite your evaluation. The BACB is not responsible for messages that are not received in a timely manner due to the applicant s failure to check email or due to the applicant s failure to notify the BACB of an email address change. To ensure that important messages from the BACB are not blocked by SPAM and junk email filters, add applications@bacb.com to your address book and BACB.com to your list of safe domains. ACCEPTABLE COURSEWORK All coursework used to qualify for BACB certification must be college or university coursework taken for academic credit at an institution that is: 1. A United States or Canadian institution of higher education fully or provisionally accredited by a regional, state, provincial or national accrediting body; or 2. An institution of higher education located outside the United States or Canada that, at the time the applicant was enrolled and at the time the applicant graduated, maintained a standard of training equivalent to the standards of training of those institutions accredited in the United States. work must be behavior analytic in nature and cover the content areas specified on the Content Verification form. work must be passed with a grade of C or better. Audited coursework will not be accepted. Non-university training will not be accepted. Continuing education workshops will not be accepted. Only coursework taken for graduate credit will be accepted toward BCBA-level applications. Undergraduate coursework will not be considered for a BCBA-level application. ACCEPTABLE DOCUMENTATION You must complete two Content Verification Forms; one showing how you believe your coursework Page 2 of 10
Board Certified Assistant Behavior Analyst work Evaluation Form ver. 4/14 applies toward the BACB s Third Edition coursework requirements and one showing how you believe your coursework applies toward the BACB s Fourth Edition coursework requirements. In order to evaluate your coursework, the BACB also requires documentation that the content of the courses listed on your transcript and on your Content Verification Form are behavior analytic in nature and meet the content requirements. The preferred documentation is a full syllabus for each course to be evaluated, including a calendar of course topics covered. If these are not available or are insufficient, the BACB may request that you obtain a letter (or letters) on university letterhead in which the professor, chair of the department, or your major advisor attests that the course was behavior analytic and meets the specific content requirements you have claimed. An individual writing such a letter should be a behavior analyst, and the BACB reserves the right to request the faculty's Curriculum Vitae or other documentation. The letter should contain the name/number of the appropriate course(s) on the transcript and how many classroom contact hours of behavior analytic instruction were accrued in each content area for each course. We strongly suggest that you refer directly to the BCBA and BCaBA course content requirements when preparing the letter. Transcripts are not required to perform a coursework evaluation. However, please note that the BACB will require official university-issued transcripts (in unopened envelopes) in order to verify all courses before you will be allowed to sit for an examination. These transcripts may be submitted with this coursework evaluation or you may wait to submit them with your application for examination. Any discrepancies between the coursework submitted with this application and the courses as they appear on your transcripts may cause your coursework not to be accepted. Please ensure that the course names and numbers provided in this application and on your documentation of course content (syllabi) correspond to the course names and numbers on your transcripts. Page 3 of 10
Board Certified Assistant Behavior Analyst work Evaluation Form ver. 4/14 PART A: APPLICANT PROFILE Complete all parts of this application and include all required documentation and attachments. Incomplete applications may not be processed. I am applying for: Original Application Complete all parts of application. Board Certified Assistant Behavior Analyst coursework evaluation Board Certified Behavior Analyst INCORRECT FORM see form for BCBA Check here if you are currently a BCaBA. Check One: Mr. Ms. Mrs. Dr. Legal Last Name First Name MI PLEASE PRINT OR TYPE LEGIBLY. YOU WILL BE REQUIRED TO SHOW PHOTO ID THAT EXACTLY MATCHES THE NAME LISTED ABOVE IN ORDER TO BE ADMITTED TO THE EXAMINATION. THE SPELLING OF YOUR NAME ON THIS APPLICATION WILL ALSO BE USED ON YOUR CERTIFICATE SHOULD YOU PASS THE EXAMINATION. ALWAYS VERIFY THAT THE BACB HAS SPELLED YOUR NAME CORRECTLY ON CORRESPONDENCE AND NOTIFY THE BACB OF ANY NAME SPELLING ERRORS IMMEDIATELY. Address where the BACB will send all official correspondence. You must notify the BACB immediately if your address changes: Street Address Apt/Suite # City/Town State (USA) Zip Code (USA) Non-USA County/Parish/State Country Non-USA Postal Code Telephone Number: WORK ( ) - x FAX ( ) - HOME ( ) - International Dialing Code Email is the PRIMARY communication mode with you on needed additional materials. The BACB is not responsible for messages that are not received in a timely manner due to the applicant s failure to check email or applicant s failure to notify the BACB of a change in their email address. Email address: (Print clearly; use Ø to distinguish from the letter O, capitalize L and I to distinguish from 1.) I have enclosed the following required materials: Application Fee of $100 Completed Third Edition Content Verification Form Completed Fourth Edition Content Verification Form A syllabus for each course listed on the Content Verification Forms Page 4 of 10
Board Certified Assistant Behavior Analyst work Evaluation Form ver. 4/14 MANDATORY CERTIFICATION PROCESSING AGREEMENT The Behavior Analyst Certification Board agrees to process this application subject to your agreement to the following terms and conditions: 1. To read, remain current, be bound by and comply with all BACB rules relating to eligibility, certification, renewal, recertification, reentry and conduct, including, but not limited to, payment of applicable fees (which are non-refundable), demonstration of educational and experiential requirements, satisfaction of renewal and continuing education requirements, compliance with the BACB disciplinary standards, and compliance with all BACB documentation and reporting requirements, as may be revised from time to time, with notice of revisions to be published in the BACB Newsletter and/or on the BACB website. You are responsible for checking the BACB website regularly for changes, revisions and additions to the standards and you are deemed to have received notice of the changes, revisions and additions within 30 days of the date they are posted on the website. 2. It is the policy of the BACB not to release candidate information provided and contained in BACB applications, unless such information relates to pending or final disciplinary actions and/or is requested by a state or federal licensing authority, agency, court of law, or otherwise properly subpoenaed 3. To hold the BACB harmless, and to waive, release and exonerate the BACB, its officers, directors, employees, committee members, panel members and agents from any claims that you may have against the BACB arising out of the BACB s review of this application, or any future applications relating to eligibility for certification, renewal, recertification or reinstatement, conduct of the examination, issuance of a disciplinary (professional conduct) sanction or decision, and/or publication or third-party disclosure in accordance with Clause 2 of this Agreement. 4. To accurately identify to others (including employers and clients) that BACB certification, if granted, acknowledges that you have met the BACB's minimum standards, but does not warrant or guarantee your competence to provide professional services, and to indemnify the BACB from and against any liability that may arise from the BACB's issuance of your certification or recertification and your professional practice. 5. To only provide information in your application to the BACB that is true and accurate to the best of your knowledge. You agree to revocation or other limitation of your certification, if granted, should any statement made on this application or hereafter supplied to the BACB be found to be false or inaccurate or if you violate any of the rules or regulations of the BACB. 6. Upon review of this request for evaluation, the BACB will provide the applicant with a summary of the coursework that can be accepted and, if applicable, a summary of coursework hours still needed to meet the coursework portion of the BACB s eligibility requirements. The determinations made based upon this application will be used toward future applications, subject to final verification upon submission of a full certification application to the BACB. By submitting this application, you acknowledge and affirm that you have carefully read and understand these rules and requirements and that you agree to abide by these terms. SIGNATURE: PRINTED NAME: DATE: Page 5 of 10
Board Certified Assistant Behavior Analyst work Evaluation Form ver. 4/14 COURSE CONTENT VERIFICATION FORMS INSTRUCTIONS The Content Verification Forms are used to show how your coursework applies toward the BACB s coursework requirements. You may make and use additional copies of the forms, if necessary. You should complete both versions of the Content Verification Form (3 rd Edition and 4 th Edition) for a comprehensive evaluation. For more detailed information about topics included in each content area, refer to the BACB s Third Edition Task List for the Third Edition form. Refer to the Fourth Edition Task List and the Fourth Edition Content Allocation for the Fourth Edition Form. All of these documents are available in the Downloads section of www.bacb.com. For each course listed, give course number and course title in column heading and number of contact hours of instruction for each content area. (Typically, 1 semester credit equals 15 contact hours and 1 quarter credit equals 10 contact hours.) Make a notation next to any courses that were not taken oncampus (e.g., distance course or online course. ) Only instruction hours, such as in-person classroom time, can count as contact hours toward the coursework requirements. For independent study courses, face-to-face time with the instructor may be counted. Online or distance course syllabi must show how instruction time is accomplished. Time spent in additional activities such as reading, completing assignments, fluency drills, fieldwork, etc. will not be accepted as contact hours hours may be broken up to meet multiple content requirements, but cannot count twice. s that are from an Approved Sequence do not need to be evaluated because they already have approved content hours established as part of the course sequence approval process. You are welcome to list approved courses you have taken, in order to provide a full picture of all of the coursework you have taken. However, you should list only the approved hours for approved courses. The BACB will not deviate from the approved hours without written justification from the course sequence contact person. If you do not know the approved hours for your approved coursework, you can obtain that information by requesting the Content Verification Form from the course sequence s contact person. The contact person for each approved course sequence can be emailed using the links on the "Approved University Training" section of www.bacb.com. SAMPLE BCaBA COURSE CONTENT VERIFICATION FORM THIRD EDITION Page 6 of 10
Board Certified Assistant Behavior Analyst work Evaluation Form ver. 4/14 Applicant Name: Institution Name: J. KNITT LYONS STATE UNIVERSITY CONTENT AREA AND REQUIRED NUMBER OF CLASSROOM HOURS 1 #PSY 4001 Title: Basic Principles of ABA 2 #PSY 4002 Title: Assessment in ABA 3 #PSY 4003 Title: Advanced Techniques in ABA Total Hours for content area a. 10 hours ethical considerations in behavior analysis b. 40 hours in definitions and characteristics & principles, processes and concepts c. 25 hours in behavioral assessment & selecting intervention outcomes strategies d. 20 hours in experimental evaluation of interventions and measurement of behavior & displaying and interpreting data e. 40 hours in behavior change procedures and systems support Total Hours of Instruction for course 5 5 10 40 40 25 25 15 5 20 45 45 45 40 40 TOTAL 135 *For example, behavior analytic applications in topic areas such as autism, organizational behavior management, behavioral pharmacology, etc. as long as the coursework content hours listed are behavior analysis applications. Page 7 of 10
Applicant Name: Institution Name: Board Certified Assistant Behavior Analyst work Evaluation Form ver. 4/14 BCaBA COURSE CONTENT VERIFICATION FORM THIRD EDITION CONTENT AREA AND REQUIRED NUMBER OF CLASSROOM HOURS 1 2 3 4 5 Total Hours for content area a. 10 hours ethical considerations in behavior analysis b. 40 hours in definitions and characteristics & principles, processes and concepts c. 25 hours in behavioral assessment & selecting intervention outcomes strategies d. 20 hours in experimental evaluation of interventions and measurement of behavior & displaying and interpreting data e. 40 hours in behavior change procedures and systems support Total Hours of Instruction for course TOTAL MAKE ADDITIONAL COPIES OF THIS FORM IF MORE THAN FIVE COURSES USED Page 8 of 10
Board Certified Assistant Behavior Analyst work Evaluation Form ver. 4/14 SAMPLE BCaBA COURSE CONTENT VERIFICATION FORM FOURTH EDITION Applicant Name: Institution Name: J. FREDERICK XAVIER MAIN COLLEGE CONTENT AREA AND REQUIRED NUMBER OF CLASSROOM HOURS Institution is on the following system (check one): Semester Quarter Other (attach description) 1 Foundations of Behavior Analysis 2 Assessment & Ethics in Behavior Analysis 3 Applied Practice in Behavior Analysis I 4 Applied Practice in Behavior Analysis II Total Hours for Content Area A B C D 15 hours in ethical & professional conduct 45 hours in concepts & principles of behavior analysis 10 hours in measurement (including data analysis) 5 hours in experimental design 30 hours in identification of the problem & assessment 45 hours in fundamental elements of behavior change & specific behavior change procedures 5 hours intervention & behavior change considerations 5 hours in behavior change systems 5 hours in implementation, management & supervision 15 15 45 45 10 10 5 5 30 30 15 30 45 5 5 5 5 5 5 E 15 hours in discretionary 15 15 Total Hours of Instruction 45 45 45 45 TOTAL 180 Appropriate Experimental Analysis of Behavior coursework may be used to fulfill requirements in b, and d above. Page 9 of 10
Board Certified Assistant Behavior Analyst work Evaluation Form ver. 4/14 BCaBA COURSE CONTENT VERIFICATION FORM FOURTH EDITION Applicant Name: Institution Name: CONTENT AREA AND REQUIRED NUMBER OF CLASSROOM HOURS Institution is on the following system (check one): 1 2 3 4 5 6 Total Hours for Content Area Semester Quarter Other (attach description) A B C D 15 hours in ethical & professional conduct 45 hours in concepts & principles of behavior analysis 10 hours in measurement (including data analysis) 5 hours in experimental design 30 hours in identification of the problem & assessment 45 hours in fundamental elements of behavior change & specific behavior change procedures 5 hours intervention & behavior change considerations 5 hours in behavior change systems 5 hours in implementation, management & supervision E 15 hours in discretionary Total Hours of Instruction TOTAL Appropriate Experimental Analysis of Behavior coursework may be used to fulfill requirements in b, and d above. MAKE ADDITIONAL COPIES OF THIS FORM IF MORE THAN SIX COURSES USED Page 10 of 10