Instructions for TSRC Category 1 CERT Program Approval Application
Provide the name of primary sponsoring organization of the educational activity and the name, address, and telephone number of a program coordinator to whom all correspondence and additional information may be sent.
Provide information about the program title and dates. If the program is repeated, attach a separate sheet detailing all additional dates and locations. Programs may not extend beyond 12 continuous months from the date of approval.
Calculate the total number of CERT hours you are requesting by adding up the number of instructional contact hours.
This does not include registration periods, introduction (unless instructional, with objectives), breaks, meals, social activities, and evaluation activities. Round time to the nearest hour (3 hours, 45 minutes = 4 CERT hours; 3 hours, 15 minutes = 3 CERT hours).
Explain how you assign partial credit, if you permit it. Some programs are made up of educational activities that are independent of one another (i.e., you may have individual lectures or seminars in your program) and an attendee does not need to participate in all parts of the program. Please attach a separate sheet explaining on what basis partial credit will be allowed and how partial attendance will be verified.
Indicate what the target audience for your program is and the teaching methods used to convey the program information.
Indicate the cost, if any, to the program participant to attend the program.
Check the appropriate box, based on the sponsor’s status. Not-for-profit sponsors are defined as having a federal tax ID number and a certificate of exemption. You must pay the for-profit fee if you do not meet this definition. Fees are waived for TSRC Region and TSRC District programs. Programs received less than 30 days prior to the event will be required to submit late fees as specified. Additional fee will be charged for program over 12 hours.
- 1-6 CEUs – $70
- 7-12 CEUs – $110
- Subsequent / Repeat dates – $10 each date
- Each hour over 12 hours – $10
- 1-6 CEUs – $ 100
- 7-12 CEUs – $140
- Subsequent / Repeat dates – $20 each date
- Each hour over 12 hours – $10
Program Forms / Enclosures
Complete CERT Level 1 – Form A to provide important details about educational program or activity. You may have several lectures in a single program; therefore, fill out complete information on each lecture. A separate CERT Level 1- Form A should be fill out for each individual lecture or activity. Indicate the date of lecture, time lecture is being given (e.g., 8:30 AM – 9:30 AM) and the length of that program (one hour). This will be helpful in calculating the total number of CERT hours requested. Provide the name of the speaker and his/her qualifications (credentials, education, background, and/or experience) to speak on the topic assigned.
You must include a minimum of 2 learner objectives for each lecture or event in your program. Please list what you expect the participant to learn or be able to do after attending the lecture. Share these with the program participants.
In order to receive CERT credit, it is essential that you have an evaluation of your program. Please tell us how you will determine if learner objectives were met. Evaluation methods should be appropriate for the objectives and content of the program. Do not send us your evaluation form.
Attach a copy of your program brochure or schedule with your application.
For a non-TSRC sponsored program, the TSRC is absolved of all financial responsibility that may be incurred by the program including, but not limited to, food and beverage, audio/visual, labor, decorations, or damages. The TSRC is not responsible for advertisement, promotion, registration, or collection of participant fees. The sponsoring entity may choose to declare all participants be a member of the TSRC to attend. At that time, all membership applications and fees will be issued to the TSRC within 7 days after the program date. Validation of TSRC membership of a participant can be requested by the sponsoring organization prior to the program date. It is the responsibility of the program participant to ensure they can show proof of membership of the day of the program. The TSRC is acting only as the approving body for the CERT hours being issued.
The TSRC will provide a template of a Level 1 CERT certificate to the program coordinator with course number, date of program and location of program to be printed by the sponsoring organization and provided to all participants. The program coordinator will need to sign the printed CERT certificate for validation of issuance. The TSRC will provide a CERT Level attendance to the program coordinator. All participants receiving a CERT certificate must sign the attendance log. A copy of the CERT Level 1 attendance log must be returned to the TSRC within 7 days after the date of the program conclusion. Sponsoring organization must retain program evaluations, the original CERT Leve1 attendance log and the CERT certificate template for 3 years. The sponsoring organization is responsible for providing a replacement CERT certificate at the request of any participant for licensure audit purposes. Sponsoring organization may charge participant for replacement at the discretion of the sponsoring organization. The TSRC is not responsible for providing replacement CERT certificates for any program not sponsored by the TSRC.