Approved TeleSupervisor (ATS)
Initial Application

Contact Details

Prefix

First Name *

Middle Name

Last Name *

Suffix

Email Associated with Your CCALP Account *

ALWAYS use the same email address for CCALP activity. This ensures that all of your form submissions, payments and exam scores are accessible when you log in.

Mobile Phone Number *

I would like to receive Text Messages related to my certification(s). I understand that I can reply STOP at any time to unsubscribe.

CPCS # *

Please upload your attendance CEs from the 2-day Approved TeleSupervision workshop *

Acknowledgment & Attestation Statements

I attest that I have read and agree to the following:

My application is subject to the rules, bylaws, and other governing provisions of CCALP.
I agree to abide by the policies and regulations of CCALP.
I agree to surrender my certification/candidacy if found in violation of the above by CCALP.

By my signature, I attest that the information I submit herein or in any required accompanying or subsequent documentation is true and accurate to the best of my knowledge. I understand that persons who apply for certification are subject to CCALP’s eligibility requirements for certification and recertification. *

Clear

Certification Fee *

Approved TeleSupervisor (ATS) Certification

$175