PERCEPTION-ACTION APPROACH CERTIFICATION PROGRAM APPLICATION

PERCEPTION-ACTION APPROACH CERTIFICATION PROGRAM APPLICATION

Thank you for your interest in the Certification Program for the Institute for Perception-Action Approach (further known IPAA). Please complete the form below. Once completed this form will be forwarded to Charlene Fregosi- Certification Committee Chair, charlene.fregosi@perceptionaction.org. There is a non-refundable fee of $25.00 due at application.

If you have questions about this Application, please contact Charlene Fregosi at the above email address.

The IPAA staff will acknowledge receipt of your P-A Approach Certification Program Application within two weeks and will let you know if additional information is needed to fully process your application. When your application is approved you will be emailed a code to access the next phase of the process.
Contact Information
Personal:
Name*

First NameLast Name
Address*

Street Address

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CityState / Province

Postal / Zip Code
Home Phone*
Please enter a valid phone number.
Cell Phone*
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Email*
example@example.com
Professional:
Professional License*
State*
License Number*
Expiration*
Employed by*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Please enter a valid phone number.
Email*
example@example.com
Choice of Program/s*

Mentoring Course $600Project Course (prerequisite Mentoring Course) $450Bundled Discounted Mentoring and Project Course $900
Professional Practice:

P-A Approach Experience:
Have you taken any P-A Approach courses? If yes, please list the names, dates and Instructor(s).*
How often have you practiced the principles and manual guidance presented in the above courses?*
Please state briefly why you want to join the P-A Approach Certification Program. Attach comments to Application.*
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Please tell us about your current practice, including the types and ages of children you see, how many sessions per week you provide intervention and whether it is home, clinic or school based.*

Application Fee*

Application FeeNon-refundable fee.

$25.00 Quantity

Total

$0.00

Credit Card Details
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Credit Card Number	Security Code
Card Expiration

Should be Empty:

Certification Program will consist of 2 courses:

Mentoring Course:

Total of six (1 1⁄2 hour) mentoring sessions – An IPAA Instructor/Mentor will be assigned to the Certification Candidate and frequency and timing of meetings will be discussed between Mentor and Candidate.
Certification Candidates can choose to do this Mentoring Course by itself or as a prerequisite to the Project Course, leading to Certification.
Following six (1 ½ hour) mentoring sessions, Candidate and Mentor will discuss Candidate’s readiness to move on to Project Course to complete Certification.
If further mentoring sessions are required, additional fees will be necessary.
Fee for Mentoring Course: $600.00

Project Course:

Acceptance to the Project Course is dependent on successful completion of the Mentoring Course.
The Candidate will provide Instructor/Examiner with two 20 minute intervention videos and a written report of one client, as further described in the Certification information.
A P-AA Instructor/Examiner will review the candidate’s intervention videos and written report and provide feedback and discussion with the Candidate.
The Examiner will provide recommendation to the Certification Committee when the Candidate has met competency for Certification. The Certification Committee will then contact the Candidate.
Fee for Project Course: $450.00

Total Fees for the Certification Program:

Application Fee: $25.00
Mentoring Course: $600
Project Course (videos and written report): $450.00
Full Certification: $1050.00 - Mentor & Project Courses are paid separately
Discounted Fee: $900.00 - Mentor & Project Courses are paid together

Empowering Children to Learn to Move and Move to Learn through the Education of Pediatric Therapists

Your donation helps IPAA continue our mission.
We are an IRS Approved 501(c)(3) Non Profit organization.

PERCEPTION-ACTION APPROACH CERTIFICATION PROGRAM APPLICATION

PERCEPTION-ACTION APPROACH CERTIFICATION PROGRAM APPLICATION

Contact Information

Personal:

Professional:

Professional Practice:

Learn with IPAA!
We offer On-demand Introductory Webinars,
Live On-line Webinars, and Live In-person Courses.

Featured links

Connect with us

Your donation helps IPAA continue our mission.We are an IRS Approved 501(c)(3) Non Profit organization.

PERCEPTION-ACTION APPROACH CERTIFICATION PROGRAM APPLICATION

PERCEPTION-ACTION APPROACH CERTIFICATION PROGRAM APPLICATION

Contact Information

Personal:

Professional:

Professional Practice:

Learn with IPAA!We offer On-demand Introductory Webinars,Live On-line Webinars, and Live In-person Courses.

Featured links

Connect with us

Your donation helps IPAA continue our mission.
We are an IRS Approved 501(c)(3) Non Profit organization.

Learn with IPAA!
We offer On-demand Introductory Webinars,
Live On-line Webinars, and Live In-person Courses.