External Review Online Application

Home

Add to Bookmark

Wednesday, May 16, 2012

Online Application

External Program Approval - Online Submission Form

The ASCH Standards of Training (SoT) Committee meets for the purpose of reviewing and approving continuing education (CE) programs offering credit toward ASCH membership and/or certification.

The following information must be submitted to ASCH for the Committee to properly review the course(s):

a. Program description;
b. Speakers, and curriculum vitae if not ASCH members;
c. Timed agenda with speaker assignments;
d. 4 educational objectives per session;
e. At least 3 primary references
f. A non-refundable payment of $10.00 U.S. per credit hour, checks payable to American Society of Clinical Hypnosis.*

*Payment not required for active ASCH Component Sections & University/College programs.

If you are submitting a hard copy of the form please download it, save it, and return it with payment (if necessary) to:

Emma Leighton
ASCH
140 N. Bloomingdale Road
Bloomingdale. IL 60108-1017
Telephone: 630-980-4740
Fax: 630-351-8490
e-mail: education@asch.net

Online submissions are preferred.

Please complete and submit the information requested below. You will be contacted shortly if your program will need to be invoiced.

Submitter Information

Contact Name:

Component Section or Institution Name:

Address:

City, State, Zip:

Telephone:

Fax:

Email:

Program Information

Please complete all the fields listed below or attach a brochure with the requested information.

Program Name:

Program Dates:

Number of Hours:

Level of Training:

Program Description (Please complete the required information in the space provided below)

Timed Agenda/Assignments (Please complete or attach the required information in the space provided below)

or attach:

Learning Objectives (You need to submit 4 learning objectives for every session. Below you will find assistance on how to compose quality learning objective and 4 questions to answer that will yield your learning objectives.)

How to write quality learning objectives:

Objectives describe the behavior of the learner, and:

• are stated clearly;

• define or describe an action; and

• are measurable, in terms of time, space, amount, and/or frequency.

Quality learning objectives should:

• Describe the information, skills, behaviors, or perspectives participants in the session will acquire through attendance and
participation;

• Clearly identify the outcomes or actions participants can expect to demonstrate as a result of the educational experiences; and

• Identify how they relate to changes in a clinicians practice and how they hope to accomplish that.

Learning objectives should address not only what the learner will learn but also how what they learned will affect change in their performance in practice thus changing patient care. Write learning objectives that relate to these outcomes and that reflect the content of the session.

Please make certain the learning objectives are quantifiable and measurable.

DO NOT USE Understand or To Learn in your objectives. They are not measurable.

Examples of Acceptable Measurable Action Words:
Explain, Demonstrate, Analyze, Formulate, Discuss, Compare, Differentiate, Describe, Name, Assess, Evaluate, Identify, Design, Define, List, Recognize, Prioritize, Create, Construct, Articulate, Apply, Assess, and Develop.

Examples of quality learning objectives.
At the conclusion of this workshop participants will:

• Be able to construct 3 metaphors appropriate for pain management

Quantifiable outcomes

• Be able to deliver hypnotic interventions to patients in an original manner

Addresses how is this presentation is changing the participants practice

• Be able to articulate and practice ego-state therapy as a new method of treatment

New skills attainment

Answer the following questions to formulate your learning objectives:

A.) What information, skills, behaviors, or perspectives participants will attendees acquire from this session?

B.) What outcomes or actions can participants expect to demonstrate as a result of this session?

C.) How will those outcomes and actions relate to changes in a clinician's practice?

D.) How might attendees hope to accomplish these changes in practice?

References (Please list three primary reference sources from which you developed the content of the workshop)

Program Website (Do you want your program listed on the ASCH website)

Speakers

Speaker:

Certification Status:

ASCH Member:

Speaker CV: