ࡱ>  M$bjbjv)v) 4(CAgCAgD 4 4 4 8l T& 4 _j6(`)v)v)v)e* * *iiiiiii$mKpriE *e*e***i v)v)j000*^ v) v)i0*i00D`Fv)ெ*XEi/j0_jpEp,p0`F`F p S**0*****ii.***_j****p*********X : "As the number of confirmed cases of the Novel Coronavirus (COVID-19) increases across the United States, the NCCDP finds it necessary to offer all NCCDP seminars for the next six weeks (and possibly longer) online. THIS PERTAINS TO NCCDP CORPORATE CLASSES TAUGHT BY NCCDP CORPORATE TRAINERS. (All other registrants must check with their instructor on the scheduling of their seminar). "As the number of confirmed cases of the Novel Coronavirus (COVID-19) increases across the United States, the NCCDP finds it necessary to offer all NCCDP seminars through December 2020. The following seminars will still take place on the day and time as scheduled; however, registered participants will receive detailed login instructions (which include needing a laptop/desktop and headset) to participate live/online." Anyone wishing to attend the ADDC online seminars, due to the National crisis, there are no distance restrictions. Contact the listed online trainers who have seminars posted and register directly with the approved online trainer. Anyone wishing to attend the ADDC online seminars, due to the National crisis, there are no distance restrictions. Contact the listed online trainers who have seminars posted and register directly with the approved online trainer. National Council of Certified Dementia Practitioners Global Leader in Dementia Education and Dementia Certification 55 Main Street, Suite 102 Sparta, NJ 07871-1909 USA Within USA Toll Free 1- 877-729-5191 Answering Service International Calls 1 973.729.5191 Answering Service 1.973.729.6601 NCCDP Office 1.973.860.2244 FAX  HYPERLINK "http://www.NCCDP.org" www.NCCDP.org  HYPERLINK "mailto:NCCDPCORPORATE@NCCDP.org" NCCDPCORPORATE@NCCDP.org CADDCT Certified Alzheimers Disease and Dementia Care Trainer Certification Application and CADDCT Seminar Application to become CADDCT Certified Alzheimers Disease and Dementia Care Trainer "One CADDCT Trainer Impacts the Quality of Care Provided by Thousands of Health Care Professionals, Front Line Staff and Students Who Provide Care to Our Most Vulnerable Elderly." You are applying to attend the NCCDP CADDCT seminar. In order to be approved and certified as a NCCDP Certified Alzheimers Disease and Dementia Care Trainer CADDCT you must attend and complete the 1-day Certified Alzheimers Disease and Dementia Care Trainer CADDCT Certification live 12- hour seminar. The seminar is a one-day live seminar but may be offered over two days. Check the attached schedule carefully. Please print out entire CADDCT application, complete the entire application and mail the entire application to NCCDP to be considered for the Certified Alzheimers Disease and Dementia Care Trainer certification CADDCT seminar. Please mail the entire application to the above address with your payment. If, you are a Dementia unit manager working in an Assisted Living or Nursing Home community, you may also be interested in CDCM Certified Dementia Care Manager certification. This is a 3- hour conference call and includes a memory care neighborhood policy and procedure manual. Please, click on certifications and Dementia Unit Manager CDCM tab to download the CDCM application. You must complete CADDCT first before applying for CDCM. We recommend sending your packet signed receipt and to utilize a service such as FEDEX or UPS. If this is a last-minute registration please scan in or fax to 19738602244. We do NOT recommend scanning in the credit card form if you are paying by credit card. Please scan in all other documents, if youre a last-minute registration but not the credit card form. If scanning, call the NCCDP office directly with the credit card information. If faxing in, you can fax the credit card form with the application. If you are scanning in or faxing in, please notify NCCDP at  HYPERLINK "mailto:nccdpcorporate@nccdp.org" nccdpcorporate@nccdp.org. If you are mailing in the application using FEDEX or UPS or Postal Service Certified Mail please note the office is not open on weekends. If, you are approved for the CADDCT Certified Alzheimers Disease and Dementia Care Trainer certification seminar, you will be sent via your work email address, an acknowledgement package. The acknowledgement packet will include homework assignments and two different contracts, a license agreement and instructor agreement. The acknowledgement packet is scanned to your work email address only. If you are not approved and you paid by check a refund check will be sent to you. If you are paying by credit card the payment will not be processed unless you are approved for the seminar. The application and supporting documents will not be returned. If you are not approved you will be notified by mail or email. Refunds will take 4 to 6 weeks to process. There is a 35.00 returned check fee for bounced checks. Payment is expected at the time your application is submitted to the NCCDP. Be sure to check all pages to insure you have completed all areas and signed all required areas of the Certified Alzheimers Disease and Dementia Care Trainer CADDCT pre-registration application. Upon completion of the CADDCT seminar you will be awarded the certifications and credentials of CADDCT Certified Alzheimers Disease and Dementia Care Trainer and Certification as CDP Certified Dementia Practitioner . You will also receive all training materials during the seminar. Who Should Attend CADDCT Certified Alzheimers Disease and Dementia Care certification seminar: The CADDCT Certified Alzheimers Disease and Dementia Care certification seminar is recommended for In-service Directors, Nurse Educators, Corporate Trainers, Nurses, Social Workers, Dietitians, Physicians, Activity Directors, CTRS and Recreation Therapists, Psychologists, Psychiatrists, Dementia Unit Managers, Surveyors, Department Heads, Health Care Organization / Company Owners, Management Company Trainers, Administrators, Rehab Directors, OT, PT, Speech, Medical Directors, State Surveyors, AOA Trainer, Ombudsman Trainers Consultants, Pharmacists, Support Group Leaders and Clergy who are responsible for training health care professionals, front line staff and volunteers who work in Nursing Homes, CCRCs, Assisted Living, Adult Day Care, Home Care Agencies, Hospitals, Retirement Homes, Senior Communities, Rehabilitation Centers, Psychiatric Facilities, Senior Centers, Retirement Communities AOA, State Ombudsman Offices, Associations, Government Agencies, Visiting Nurse Agencies and, Hospice Agencies. The CADDCT seminar is also open to college professors and trainers teaching health care courses and degree programs for trade schools, colleges and learning institutions. Qualifications: To apply for the CADDCT seminar and become a NCCDP CADDCT Certified Alzheimers Disease and Dementia Care Trainer, YOU DO NOT NEED TO BE A CDP PRIOR TO ATTENDING THIS SEMINAR. The applicant must meet the following criteria: Certified or licensed in a health care profession OR/ Master level education or PhD. Or educator for a learning institution in lieu of a Masters. 4 Year college degree or graduate degree from an accredited college or RN, LPN, LVN or NP. A minimum of 5 years experience in a health care related field / profession OR an educator in a learning institution. Minimum of 1 years experience presenting in-services or seminars to health care related topics to professional and frontline staff in a geriatric setting OR presenting health care curriculum or related topic to students enrolled in a health care profession at a learning institution. There are always exceptions to the rule, if you do not fit into the criteria, please call NCCDP to discuss your options. Your application will be reviewed and if you are approved for this seminar you will receive written acknowledgement. Written acknowledgement is e-mailed to your work e-mail. The acknowledgement packet will contain two homework assignments which must be completed and returned to the NCCDP before the seminar date and also a copy brought to seminar. The home work consists of a sample brochure and a sample seminar certificate. Instructions for the home work will be contained in the acknowledgement letter. The acknowledgment packet will also contain a contract which is the license agreement /instructor agreement. The documents must be signed by a notary and returned to NCCDP before the start of the seminar. You should make a copy of the document once signed by a notary for your records. The license agreement / instructor agreement deal with intellectual property rights, copy right and trademark concerns as it pertains to the NCCDP curriculum. CFO asks CEO, What happens if we invest in developing our people and then they leave us? CEO: What happens if we dont, and they stay? ~Peter Baeklund While certification promotes and maintains quality, it does not license, confer a right or privilege upon or otherwise define the qualifications of anyone in the healthcare field." PLEASE TYPE DIRECTLY ON THIS APPLICATION. Return the entire application to NCCDP. You may fax to 19738602244 or you may mail the application signed receipt via UPS, FEDEX or US Postal Service. We recommend overnight delivery. NCCDP is closed Saturday and Sunday and will not accept deliveries on the weekend. If last minute you can also scan to  HYPERLINK "mailto:nccdpcorporate@nccdp.org" nccdpcorporate@nccdp.org BUT do not scan in the credit card form and please call 19737296601 with your credit card information. Date: ________________________ The ADDC Power Point Curriculum, Instructor Manual and Student handout notebook is available in English or Spanish. Please indicate which version you are requesting. Only one language type is provided in the CADDCT seminar price. You may purchase additional student handout notebooks in either language through the instructor only part of the web site, once you are a certified CADDCT trainer. If you require an extra curriculum set in either Spanish or English, the cost $150.00. You may not order a duplicate set in the same language. Please Check One: I am requesting ___English versionor ____ Spanish version. Please write the training date and the seminar location here: Date: ____________________________ City and State: ________________________________ NOTE: Once you sign up for the CADDCT seminar and you cancel, there is a $750.00 cancellation fee. If you cancel 7 days prior to the event there is no refund. We will allow you to move to another location one time without penalty. We make no guarantees that the next location you sign up for will not be cancelled due to poor attendance. In which case we will offer you other locations. It will be your responsibility to notify the NCCDP of the replacement location and date of training in writing. YOU CAN NOT SUBSTITUTE SOMEONE ELSE TO FILL YOUR SEAT. Name: Last: ____________________ First: ________________ Middle Name: _____________ Your name will appear exactly like this on your NCCDP certifications except in reverse order. List all license, certifications or registrations credentials that you hold? Example: CTRS, LCSW, RN ______________________________________________________________________________ Are all your credentials current? Yes ____ No ____ Your name and credentials will appear on the NCCDP web site under instructor, and or CDCM and CDP registries. (If you are a Dementia Unit Manager working in an assisted living or nursing home community and you also wish the CDCM certification please go to our site and click on certification and CDCM. You are welcome to sign up for both seminars at the time you submit your CADDCT registration for.) Home Address: _____________________________________________________________________________ City: _________________________ State: ________________ Zip Code: _________________ Country: ______________________________________________________________________ International Students Only: Please use this space, if you need extra space for your address____________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Home Phone: Area Code: ( ) - ___________________- ____________________________ Cell Phone: Area Code: ( ) - _________________- ____________________________ International Students Only: What is your country code: ____ Personal Email Address: ______________________________________________________________________________ PERSONAL E-MAIL ADDRESS IS MANDATORY. IF YOU DO NOT HAVE A PERSONAL E-MAIL ADDRESS, PLEASE GO TO ANY E-MAIL COMPANY OF YOUR CHOOSING SUCH AS AOL, YAHOO, GMAIL, ETC., AND CREATE A FREE ACCOUNT. MOST E-MAIL COMPANIES OFFER A COMPLIMENTARY E-MAIL ACCOUNT. WE WILL NOT PROCESS YOUR APPLICATION WITHOUT AN PERSONAL E-MAIL ADDRESS. YOU CAN NOT USE YOUR SUPERVISOR OR ANOTHER COWORKERS E-MAIL ADDRESS. Emergency Contact Name: ______________________________________________________________________________ Emergency Contact Phone Number: Area Code ( ) - __________________-_____________ LAST 4 DIGITS OF YOUR Drivers license or state issued identification: _________________ Employment History: Company Name: ______________________________________________________________________________ What type of business? Ex. Nursing Home, Hospice, Home Care, Private Management ______________________________________________________________________________ Your Position / Title: ______________________________________________________________________________ Your Supervisors name, title, phone number and email address? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ I understand that my supervisor may be contacted to verify employment? Initial here: ____ Company Address: _____________________________________________________________________________ City: _______________________________________ State: __________ Zip Code: _________ Work Phone: Area Code: ( ) - ______________________________- _________________ Your work email: _____________________________________________________________________________ Company Web Address: _________________________________________________________ Are you part of a chain or franchise, if so what is the corporate name? _____________________________________________________________________________ Dates of employment: Start Date: _________________ Last Date: ______________ If less than five years be sure previous information is listed on your resume. What college did you graduate from (Highest level)? Under graduate ___ Masters __ PhD ___ Name of College:_______________________________________________________________________ Year You Graduated: _________ Degree (s) Awarded: ______________________________________________________________________________ Credentials: List all your licenses, certifications, registrations, etc. List the name of the governing body that awarded you the license, certification, registration, etc. List the state that holds your license, certification or registration. List the Expiration Date. Include other Alzheimers / Dementia certifications also. ATTACH a copy of at least one license, certification or registration credential. Example: ADC- NCCAP TN- 2016 ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ALL OF THE CREDENTIALS THAT YOU LISTED WILL APPEAR AFTER YOUR NAME ON THE INSTRUCTOR AND CDP REGISTRY LOCATED ON THE NCCDP WEB SITE: Please describe your current position duties: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Please list in-services or seminars that you have presented live and in person: Date: ________ Topic: __________________________________________________________ Date: ________Topic: __________________________________________________________ Date: ________ Topic: __________________________________________________________ *ATTACH A SAMPLE SEMINAR OR IN-SERVICE THAT YOU HAVE PRESENTED LIVE. What experience do you have working with Dementia patients? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ What other Alzheimers Disease and Dementia seminars have you attended? Date: _____ Topic: _____________________________________________________________ Date: _____ Topic: _____________________________________________________________ Date: _____ Topic: _____________________________________________________________ Date: _____ Topic: _____________________________________________________________ ACKNOWLEDGEMENT THAT I WILL RECEIVE NCCDP LICENSE AGREEMENT and NCCDP INSTRUCTOR AGREEMENT UPON ACCEPTANCE INTO THE CADDCT CERTIFIED ALZHEIMERS DISEASE AND DEMENTIA CARE TRAINER CERTIFICATION SEMINAR: Please note that each trainer is required to sign a NCCDP Instructor Agreement / License Agreement prior to starting the seminar. Both documents require a notary. The NCCDP Instructor Agreement / License Agreement will be e-mailed to each applicant upon receiving the Certified Alzheimers Disease and Dementia Care Trainer seminar pre-registration application, approval of applicant and processing of full payment. The NCCDP License Agreement deals with NCCDP intellectual property and specifically states, that none of the training materials can be copied in any format, how the seminar can be taught, etc. The NCCDP License / InstructorAgreement also deals with intellectual property, copy right issues, conduct, expectations of the trainer, student handout notebooks requirement, CDP applications, advertising your seminars, etc. You are required to order extra copies of the student handout notebook from the NCCDP web site. Trainers will never collect the CDP applications, nor collect the CDP application fee nor approve CDPcertification. Only the NCCDP credentialing body can approve applicants who are applying for and qualify for the distinguished designation and certification CDP Certified Dementia Practitioner. Further, anyone can take the NCCDP Alzheimers Disease and Dementia Care seminar by an approved NCCDP Alzheimers Disease and Dementia Care Trainer but not all students qualify for CDP certification. You are required to point to the application in the student handout notebook at every seminar. Other than that, any questions a student may have should be directed to the NCCDP. The agreements do not require that the trainers pay any additional fees to NCCDP for any money that the trainer collects for your advertised ADDC seminars thatyou the trainerpresents. Some trainers elect to only teach for their facility or agency where the trainer is employed, while others advertise and teach privateseminars where the student pays the trainer directly for the ADDC Alzheimers Disease and Dementia Care seminar. You will never charge employees where you are employed. You are required to advertise all seminars on the NCCDP web site seminar calendar page, regardless if the seminar is open to the public. There is no charge to advertise on the NCCDP calendar web page. If you want to discuss or preview the agreements prior tomailing in your CADDCT preregistration form and payment, please contact NCCDP for more information. THE CONTRACTS AND HOMEWORK ASSIGNMENTS MUST BE RETURNED BEFORE THE SEMINAR DATE. IF THEY ARE NOT RETURNED BEFORE THE SEMINAR DATE, YOU WILL NOT RECEIVE YOUR PRODUCTS NOR YOUR CERTIFICATIONS. YOU WILL BE ALLOWED IN SEMINAR BUT YOU WILL NEED TO BRING YOUR OWN PAPER FOR NOTES.. If WE HAVE TO SHIP YOUR PRODUCT TO YOUR WORK ADDRESS, AFTER THE SEMINAR DATE, YOU WILL BE RESPONSIBLE FOR FEDEX CHARGES. I understand that the license agreement / instructor agreement will be e-mailed to me and the documents must be signed by myself and a notary. I understand I must fax these documents to the NCCDP prior to the seminar date. Fax 1-973-860-2244. Signature: ________________________________________________ Date: ________ ACKNOWLEDGEMENT STATEMENT: I understand that all training materials are the property of the NCCDP and are copy right protected by the NCCDP. I understand I may never copy nor distribute in any format the curriculum power point provided to me on the memory stick, or that I may have received via email download, the instructor manual, lose handouts, text books, answers nor the movie. Regardless of who pays for the seminars, I the CADDCT trainer, am the only one who may touch or utilize the training materials. I understand I am not authorized to train other trainers to be NCCDP CADDCT trainers. I understand I may not alter nor change the curriculum nor the student handout notebook in any way. I understand I am required to provide each student the NCCDP Student Handout Notebook either in a 3-ring binder with tabs or spiral bound notebook with tabs. I understand that I will provide a student handout notebook to all students exactly the way it was provided to me in the CADDCT seminar. I understand I may not alter the student handout notebook. I understand that all student handout notebooks for the ADDC seminar will be ordered through the NCCDP web site. I understand I will show the sexuality video and only the sexuality video provided to me when presenting the ADDC seminar. I understand that I will present the ADDC curriculum for a minimum of 8- hours and in its entirety. I understand that I am never allowed to collect CDP applications, or fees associated with the CDP application. I understand that I am not authorized to tell any student that they are certified as a CDP Certified Dementia Practitioner just because they attended the ADDC Alzheimers Disease Dementia Care Seminar. I understand that I will not advertise the seminar as a CDP course and will only advertise the course as the ADDC Alzheimers Disease and Dementia Care Seminar. I understand that I am required to post all ADDC seminars on the NCCDP web site calendar. I understand that all students will sign in on a sign in sheet with their name and email address, that each student will be provided a certificate of attendance and an evaluation. I will send a copy of the class certificate for each seminar, sign in sheet and class evaluations to the NCCDP within 7 days of the seminar. This can be via scan, fax or mail. I understand I will collect evaluations and store those for two years. In the event you are audited, you will need to provide those to the NCCDP. I understand that I will need a personal lap top computer with a video player, Microsoft Power Point software, a screen, extension cords, projector and speakers. Your lap top needs the capability to play movies. The curriculum and movie are provided to you on a memory stick. I understand the NCCDP ADDC Power Point Curriculum, Instructor Manual and Student Handout Notebook are updated every two years and I will discontinue use of old materials once I am notified of the new curriculum. I understand there is a nominal fee for the updated curriculum. I will inform all students that there is no form of videotaping nor the use of lap tops in seminar. I will ensure that the Power Point presentation is never screen shot using any device. I understand that If I am charging a fee for the seminar that the fee will be based on industry standards. We recommend a fee of $195.00 pp. which includes a student handout notebook. We recommend a flat rate unlimited attendance plus pp notebook fee when presenting before an association state or national conference or for a corporation. I understand that I can attend another CADDCT seminar at no charge with proper notification to NCCDP unless you are in violation of the license agreement or if NCCDP receives numerous complaints. I understand that it is my responsibility to develop marketing tools and databases to market the seminar, register students, collect fees and present the seminar. I understand that I can not market the seminar nor advertise these credentials of CDP and CADDCT or CDCM until I have completed the seminar and received my certifications. If you violate the license agreement or if NCCDP receives multiple complaints, NCCDP reserves the right to require that you attend another CADDCT seminar at your own expense. You are responsible for all travel costs. You will not be allowed to present the NCCDP curriculum until this is completed. If the violation continues, NCCDP reserves the right to revoke your CADDCT credential and the ability to present the NCCDP curriculum. Please sign here: _______________________________________ DATE: _____________ Print name: __________________________________________________________________ CHECK HERE: I have attached the following: ___ A Sample in-service or seminar that you have presented. You did not need to have a hand in the creation of the seminar or in-service. ___ Copy of your license or certification except for Nurses: Nurses will provide a copy of your license from the state registry that shows you are in good standing. If you do not have a license or certification please explain why? Certification and license must be current. If you have a license or certification that requires a 4 year degree, you do not need to provide a copy of your college degree or transcripts. Example: RN, CTRS, PT. ___ Copy of your degree or transcripts from an accredited college. If you have a masters and or PhD, we will need copy of one of the degrees. Nurses are not required to show this. If, you have a license that requires completion of a 4 year degree in order to obtain your license such as LNHA, Physical Therapist, CTRS, etc., then we do not need a copy of your degree. ___ Resume which shows employment for the last five years. ___ Code of Ethics is signed: Be sure to check all areas of this application and sign / initial where indicated. ___ Payment: Cashiers check, Money order, Check or Credit card. For checks, please make payable to the NCCDP. If your application is denied, your application nor supporting documents will be returned to you. Please make copies of the application and supporting documents for your records. Signature: ________________________________________ Date: ____________________ *Please note that for lunch we will have an open menu but we are restricted by choices that the hotel provides and may not accommodate every diet. Please check with the hotel if you are on a restricted diet. INITIAL AND DATE: ____________________________________ The following materials are provided in the CADDCT seminar: ADDC curriculum Power Point format on a flash drive, instructor notebook (power point curriculum is presented in note format to assist you in taking notes during the seminar), master handout student handout notebook, text Books on diagnosis, environment, activities and communication, Sexuality and Staff Concerns movie is on a on a flash drive, pretest / posttest (for the employees and only required if your corporation requires tests), sample brochure, sample sign in sheet, sample seminar certificate, information on obtaining CEU approval, marketing recommendations and where to obtain databases, certification as a CDP Certified Dementia Practitioner and certification as a CADDCT Certified Alzheimers Disease and Dementia Care Trainer. The ADDC Curriculum Power Point Memory Stick, Instructor Manual of the power point in note format, Loose Handouts, Movie and Text Books may never be copied nor distributed in any format to anyone! All trainers are required to provide a student handout notebook exactly the way it is provided to you, to each student attending your seminar. All student handout notebooks may only be ordered through the NCCDP printer. The student handout notebooks are $25.00 per notebook and subject to change. Shipping is free for bulk orders as long as the bulk order is a minimum of $150.00 and the printer is provided a 3-week lead time. Orders are shipped FedEx ground service. You may order the notebooks either in a 3-ring binder with tabs or spiral bound with tabs. Each student must be provided a certificate of attendance, evaluation and sign in sheet. Student handout notebook price subject to change. To log into the instructor part of the web site you will need your instructor number and email address. Once there you will click on bulk orders. LAP TOPS AND OR ANY OTHER TYPE OF RECORDING DEVICES ARE PROHIBITED IN SEMINAR. CELL PHONES AND OTHER ELECTRONICS ARE TO BE TURNED OFF Meals are provided on the day of the seminar: Light continental breakfast and lunch. We are limited to the choices provided by the hotel menu. Please check with the hotel conference center, if you are on a restricted diet. Price: $2,800 late registration fee if received 59 days prior to the start of the seminar. $2,500.00 early registration if received 60 days prior to the start of the seminar. Corporate discounts available for multiple trainers. Please request the rate sheet from NCCDP. Ask about discounts for multiple trainers for corporations or associations. Type of payment: We accept personal checks, cashier checks, certified checks made payable to the NCCDP and credit cards, If, you are from outside of the United States, we accept only credit card payments. Payment is in USD. Mailing Address: NCCDP 55 Main Street, Suite 102, Sparta NJ 07871-1909 USA Returned Check Fee: A returned check fee of $35.00 USD will apply. You will not be permitted to attend the seminar if the seminar is not paid in full. If you require a bill to be sent to your corporation, please email us at  HYPERLINK "mailto:NCCDPCORPORATE@NCCDP.org" NCCDPCORPORATE@NCCDP.org stating your name, company name, persons name attending the seminar, date of seminar, location of seminar, name of seminar, price you will be paying and your email address. The bill will be emailed to you. The CADDCT seminar price does NOT include: travel, hotel accommodations, shuttle service, car rental, transfers, gas, tolls and meals (light breakfast and lunch are provided on the day of the seminar only) or any other travel arrangements. You will make your own travel arrangements. You are not required to stay at the hotel where the seminar is held and hotel rooms are not blocked. IF YOU RECEIVE AN ACKNOWLEDGEMENT LETTER WITH A DIFFERENT LOCATION INFORMATION THAN WHAT YOU SIGNED UP FOR, IT IS YOUR RESPONSIBILITY TO CONTACT NCCDP IMMEDIATELY TO CONFIRM THE ADDRESS OF YOUR TRAINING LOCATION BEFORE YOU MAKE ANY TRAVEL ARRANGMENTS. WE ALSO RECOMMEND THAT YOU CONTACT US BEFORE MAKING TRAVEL ARRANGMENTS TO CONFIRM THE SEMINAR IS NOT CANCELLED. WE DO NOT REIMBURSE YOU FOR TRAVEL ARRANGMENTS DUE TO CANCELLATION REASONS OUT OF NCCDP CONTROL.DO NOT MAKE TRAVEL ARRANGMENTS UNTIL YOU VERIFY THAT THE ACKNOWLEDGEMENT LETTER SENT TO YOU IS ACCURATE FOR THE DATE AND LOCATION OF THE CADDCT SEMINAR. We recommend, if you are staying at the hotel, that you arrive the day before the seminar and check out the day after the seminar. If checking out the day of the seminar, you must do so prior to 7:30 A.M. Cancellation Policy: You must cancel in writing via certified signed receipt mail, 30 days prior to the event. Once your payment is processed, there is a $750.00 cancellation fee. If you cancel 7 days before the seminar there are no refunds. If you do not show up on the day of the seminar, you forfeit your payment and there are no refunds. All cancellations must be in writing via signed receipt certified mail. Please allow 4 weeks to refund your money. Changing seminar locations: We understand that emergencies can happen. We allow you to change to another seminar date and location, one time without penalty. We do NOT guarantee that the new location and date wont be cancelled due to low attendance. If this happens, we will notify you and offer you another date and location. You must attend another CADDCT seminar within one year of your payment and original seminar date. Otherwise you forfeit your registration and payment. NCCDP Liability: NCCDP reserves the right to cancel a seminar due to unforeseen emergencies, weather conditions, delay or cancellation of any and all travel by airline (rail, car, bus, cruise line, etc.), death, illness, acts of terrorism and or insufficient registrations. NCCDP will not be held responsible or liable for lost wages or any fees or penalties associated with travel costs, travel changes or cancellation incurred by you in regards to hotel, air, car rental or any other means of transportation or travel arrangements. This seminar will be cancelled due to insufficient registrations. NCCDP will make every reasonable effort contact you two weeks prior to the seminar if the seminar is cancelled. If cancelled the NCCDP staff will make every effort to contact you via email, phone and text. If the seminar is cancelled, you will have the option of attending another date but there are no guarantees that the seminar will be offered in the same city or state. You will have 12 months to take another CADDCT seminar. Renewal: You are asked to renew your CADDCT certification every two years. You will be sent via email a renewal notices two months prior to your anniversary date. You are asked to renew on line. Once you renew, a new certification for CDP and CADDCT will be emailed to you. It is important that you notify us of email address changes. Or you can download directly from the web site, the CADDCT renewal application which includes certification CDP and mail in or fax in the renewal application. There is an additional fee to receive a hard copy in the mail. As of January 1, 2018, the renewal fee is $150.00 and is subject to change. You will need 10 CEUs or 10 CEs to renew. We accept any health care related topic from any source such as webinar, magazine CEUS, NCCDP online learning, live seminars and college seminars and staff in-services. We also accept any seminars you have presented. You will need a certificate of attendance as proof you attended a seminar or you presented the seminar. If you have taught the seminar at least once per year, we will accept this in lieu of additional CEUs. Updates: NCCDP updates the curriculum every two years or as needed. NCCDP sends out an e-publications several times a year and there are instructor announcements in the publications including an announcement of when the curriculum is updated. You are required to purchase the updated curriculum and to discontinue old materials. The ADDC Power Point Curriculum price is $25.00 USD for the Power Point curriculum (e-download) and is subject to change. The Power Point Curriculum will be emailed to you and you will save the new curriculum to the memory stick provided to you in seminar. If you have many CADDCT trainers in your company, each trainer needs to purchase a copy. A new instructor notebook is $40.00 USD plus shipping and is subject to change. A new master student handout notebook is $25.00 USD plus shipping and is subject to change. All bulk orders for the student handout notebooks are to be ordered through the NCCDP web site. Shipping is free on bulk orders as long as you have a minimum order of $150.00 USD and the printer has a lead time to ship FEDEX ground service. If we elect to use another video or text books, the name and price will be posted. It will be mandatory to purchase the new video and to discontinue using the previous video. What you will need to present future ADDC Alzheimers Disease and Dementia Care Curriculum: You will need a lap top with a media player, Power Point Software, Projector, Screen, Extension Cords and a cart. Information will be provided in the seminar. NCCDP Alzheimers Disease and Dementia Care Staff Education Week February 14th to the 21st We also recommend you download NCCDP Alzheimers Disease and Dementia Care Staff Education Week Feb 14th-21st FREE staff in-services and tool kit available for download November 1st to March 15th and utilize the in-services through- out the year in your ongoing Dementia education series. Seminar Time: 7:30 A.M. to 7:30 P.M. unless, otherwise noted. Location: Hotel information may not appear on this application as we do not book conference rooms until closer to the seminar date. We reserve the right to move the hotel location within the state due to availability. At times the hotel has to cancel due to unforeseen emergencies. Your acknowledgement packet will have the hotel name and address. If you have received acknowledgement letter and we change locations, we will notify you. We are not responsible for any travel costs associated with a hotel change. Typically, the front desk is not aware of the location of the conference room until the day of the seminar. If you need to obtain more information about the seminar location, contact the conference department at the hotel. It is your responsibility to verify that the acknowledgement letter matches the date and location of the training seminar you signed up for. Training Materials: All CADDCT training materials for the seminar are shipped directly to the hotel and or training location. NCCDP staff will bring the training materials to the seminar room. If you signed up last minute and the NCCDP is unable to ship the product to the hotel in time for the seminar, the products will be shipped to your work address and will be waiting for you when you return from the CADDCT seminar. If you are registering at the last minute, we recommend that you bring pen and paper to the seminar. If you did not register last minute your training materials and writing tools will be presented to you in the seminar. Replacement fee for the ADDC Power Point Curriculum is $450.00 which will be emailed to you. You may only order one replacement copy. Replacement fee for the Instructor manual is $450.00 which will be mailed to you. You may only order one replacement copy. You may not distribute nor duplicate the instructor manual nor the ADDC power point curriculum in any format using any means. You must be in good standing to order a replacement copy. DATES: Please check which seminar location you are attending ONLY if this applies to you. ___Check here if you are attending a private corporate / association state or national training: Please enter the organizations name, the date and location of your training and conference name: Example: NADONA Nashville TN March 16th the Certified Alzheimers Disease and Dementia Care Trainer Certification CADDCT Seminar What is the Name of the Association or Organization: ________________________________________________________________________Date: ________________________________________________________________________Location: ________________________________________________________________________ ___ Conference Call: Check here if you are attending the CADDCT Certified Alzheimers Disease and Dementia Care Trainer certification seminar via conference call. NCCDP will provide you the date and time and conference call in number. This is only for individuals that has been preapproved for the conference call. Did you previously attend the CADDCT Certified Alzheimers Disease and Dementia Care Trainer certification seminar as an observer? Yes __ No ___ If, yes, which location, date and what was the name of the NCCDP Corporate trainer: ________________________________________________________________________ A training date will be arranged with you once your CADDCT application, payment, supporting documents, acknowledgement documents, contracts and homework are returned to NCCDP and you have received all the training materials to review. Please note the curriculum will be emailed to you and it will be your responsibility to save to a memory stick. This is for conference calls only. You must call in advance to the NCCDP corporate office to see if you are eligible for the conference call. Do you have Dietary Restrictions? Please check one: ___Yes ____ No If yes, please explain. ________________________________________________________________________________________________________________________________________________________________________________________________________________________We will make every effort to accommodate you but we are restricted by what the hotel restaurant can provide. Please check with the hotel conference center to view the lunch menu if you are on a restricted diet. Are there any other special arrangements that should be made for you during the seminar? Yes: ___ No: ___ For example, you need to bring a Seeing Eye dog. If yes, please explain: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ System Requirements: As a trainer you will need the following equipment in order to present the curriculum. Lap top or IPAD with the ability to play movies with sound. The video is presented to you on a memory stick. Microsoft Power Point Software. If we upgrade to another software you will also need to upgrade to another version. Projector, Speakers for large crowds, Extension cords, Screen, Cart We will provide more information on these specific items in seminar. Sign and Date: _________________________________________________ Upcoming seminar dates and locations: Seminars held at the corporate office (Sparta NJ) have very limited seating and your spot is reserved on a first come first serve basis Hotels to be announced if not listed within this document. Time: 7:30 A.M. to 7:30 P.M. Dress Attire: Business Casual and please bring a sweater as the room is cold. Also note that many state and national associations host the CADDCT seminar. Ask us for information about the associations, locations and training dates. Any association hosting the CADDCT seminar will provide you with the CADDCT registration form directly from the association and you will pay the association directly. The associations are NOT listed with the following dates. Please check which seminar you are attending: [ ]October 6, 2020 - Sparta, NJ CLASS NOW HELD ONLINE VIA ZOOM[ ]October 8, 2020 - Long Beach, CA CLASS NOW HELD ONLINE VIA ZOOM[ ]October 15, 2020 - Indianapolis, IN CLASS NOW HELD ONLINE VIA ZOOM[ ]October 15, 2020 - Orlando, FL CLASS NOW HELD ONLINE VIA ZOOM[ ]October 16, 2020 - Raleigh, NC CLASS NOW HELD ONLINE VIA ZOOM[ ]October 23, 2020 - Harrisburg, PA CLASS NOW HELD ONLINE VIA ZOOM[ ]November 5, 2020 - Pittsburgh, PA CLASS NOW HELD ONLINE VIA ZOOM[ ]November 10, 2020 - Birmingham, AL CLASS NOW HELD ONLINE VIA ZOOM[ ]November 17, 2020 - Chicago, IL CLASS NOW HELD ONLINE VIA ZOOM[ ]November 19, 2020 - Nashville, TN CLASS NOW HELD ONLINE VIA ZOOM[ ]November 20, 2020 - San Diego, CA CLASS NOW HELD ONLINE VIA ZOOM[ ]December 4, 2020 - Jacksonville, FL CLASS NOW HELD ONLINE VIA ZOOM[ ]December 8, 2020 - Sparta, NJ CLASS NOW HELD ONLINE VIA ZOOM[ ]December 9, 2020 - Grand Rapids, MI CLASS NOW HELD ONLINE VIA ZOOM[ ]December 11, 2020 - Sioux Falls, SD CLASS NOW HELD ONLINE VIA ZOOM[ ]December 14, 2020 - Baltimore, MD CLASS NOW HELD ONLINE VIA ZOOM[ ]JANUARY 8, 2021 - PHILADELPHIA, PA[ ]January 12, 2021 - Kansas City, Kansas[ ]January 14, 2021 - Atlantic City, New Jersey[ ]January 22, 2021 - Riverside, California[ ]January 26, 2021 - Tucson, AZ[ ]February5, 2021 - Cleveland, OH[ ]February 14, 2021 - Portland, Oregon[ ]FEBRUARY 19, 2021 - ORLANDO, FL[ ]February 26, 2021 - Salt Lake City, UT[ ]March 5, 2021 - Las Vegas, NV[ ]March 9, 2021 - Tarrytown, New York[ ]March 12, 2021 - Omaha, Nebraska[ ]MARCH 26, 2021 - HARRISBURG, PA[ ]April 1, 2021 - Boston, MA[ ]April 16, 2021 - Denver, Colorado[ ]April 20, 2021 - Jacksonville, FL[ ]APRIL 23, 2021 - SAN DIEGO, CA[ ]May 4, 2021 - Santa Barbara, CA[ ]May 7, 2021 - Washington, DC[ ]May 11, 2021 - Chicago, Illinois[ ]MAY 14, 2021 - DES MOINES, IA[ ]May 25, 2021 - Tampa, FL[ ]June 8, 2021 - Colorado Springs, CO[ ]June 15, 2021 - Spokane, Washington[ ]JUNE 18, 2021 - PITTSBURGH, PA[ ]June 29, 2021 - Nashville, TN[ ]July13, 2021 - Rockford, Illinois[ ]July 15, 2021 - Long Beach, California[ ]July 20, 2021 - Minneapolis, MN[ ]JULY 22, 2021 - KINGSPORT, TN[ ]July 30, 2021 - San Francisco, CA You must complete the entire seminar. You cannot arrive late nor leave early and there are no exceptions. If you need to leave early, you will need to complete and pay for the entire seminar again. We do not guarantee a seat for you at the next training. If you need to repeat the seminar, seating will be based on availability. ANY QUESTIONS YOU HAVE REGARDING THE LICENSE AGREEMENTS YOU ARE TO DIRECTED TO CONTACT THE NCCDP CORPORATE STAFF, AT 1-973-729-6601 OR DIRECT EMAIL  HYPERLINK "mailto:NCCDPCORPORATE@NCCDP.ORG" NCCDPCORPORATE@NCCDP.ORG BEFORE THE SEMINAR DATE! The CADDCT Certified Alzheimers Disease and Dementia Care Trainer certification trainer seminar program: Modules to be covered are: Introduction to Dementia, Diagnosis, Prognosis, Treatment, Medications, Assessments, Communication, Feelings, Depression, Repetitive Behaviors, Paranoia, Hallucinations, Wandering, Hoarding, Aggressive Behaviors, Catastrophic Reactions, Intimacy and Sexuality, Personal Care, Pain, Nutrition, Bathing, Toileting, Activities, Environment, Staff and Family Support, Diversity and Cultural Competence, Abuse and Neglect, Spiritual Care and End of Life Issues. 7:30 A.M. to 7:30 A.M Registration and light breakfast We will review your homework which includes; sample brochure and sample certificate, corporate / conference discounts, seminar materials and trainer materials during the seminar. YOU MUST BRING YOUR SAMPLE SEMINAR CERTIFICATE AND SAMPLE BROCHURE TO THE SEMINAR. YOU MUST ALSO BRING TWO FORMS OF ID, YOUR WORK ID AS WELL AS A NONEXPIRED DRIVERS LICENSE OR PASSPORT. THIS WILL BE EXPLAINED IN THE ACKNOWLEDGEMENT LETTER IN MORE DETAIL. 8:30 A.M. to 5:00 P.M. NCCDP corporate staff presents the ADDC Alzheimers Disease and Dementia Care curriculum, review of student handout notebook, CDP application and resources. 12:00 P.M. to 1:00 P.M. Working lunch - includes questions and review. 5:00 P.M. to 7:30 P.M. Questions, marketing your seminar, where to obtain databases, how to obtain ceus approval and governing bodies, certification procedure, completion of the CDP application, sample brochure, sample certificate, sample sign in sheet, certification as a CDP and Certified Alzheimers Disease and Dementia Care Trainer CADDCT and collection of evaluations. What is Your Responsibility? The student completing the CADDCT Certified Alzheimers Disease and Dementia Care Trainer certification seminar will be issued the Instructor ID Number, certification as a Certified CADDCT Alzheimers Disease and Dementia Care Trainer and Certification as a CDP Certified Dementia Practitioner. Please note regardless of who is paying for the course the trainer owns the materials and the materials can only be used by the certified trainer. The certification will be valid for two years, from the date the CADDCT certification is issued. You must renew online every two years your CADDCT and the CDP certification is included. You will not be able to order new supplies unless you are in good standing with your CADDCT. When you renew online the new certification will be emailed to you. The instructors will log into the instructor only portion of the web site within 7 days of completing the seminar and will complete contact information and indicate which states you wish to be advertised in. This is done through the instructor only section. It is required and your responsibility to list all ADDC seminars you are presenting which is the NCCDP Alzheimers Disease and Dementia care seminar on the NCCDP website seminar calendar page. It is your responsibility to; develop databases, market the seminar, find a teaching space, collect seminar fees and provide a student handout notebook to students as well collect evaluations, collect sign in sheets and provide a certificate of attendance for the Alzheimers Disease and Dementia Care seminar. You will never advertise that you are teaching a Certified Dementia Practitioner seminar. It is your responsibility to insure you have the most up to date NCCDP curriculum and student handout notebook. It is your responsibility to provide a NCCDP Alzheimers Disease and Dementia Care student handout notebook to the students attending the seminar exactly the way it has been provided to you. You understand you cannot make changes of any kind to the NCCDP student handout notebook. You may order the student handout notebooks in bulk through the NCCDP. I have read and understand the cancellation policy, refund policy and NCCDP liability clause with regards to cancellation. I understand that the license agreement and instructor agreement will be e- mailed to me prior to the start of the seminar and must be filled out, signed by me and a notary and must be returned to the NCCDP prior to the seminar. I understand that I also will receive a acknowledgement letter with two homework assignments which must be completed and faxed to NCCDP before the seminar date and also brought to seminar. This is a sample brochure and a sample certificate. ________________________________________ _________________ Signature Date Code of Ethics National Council of Certified Dementia Practitioners Code of Ethics for Certified Dementia Practitioners (CDP) The CDP provides services to the health care profession with respect and dignity to the Dementia Client. The CDP recognizes and respects the Dementia Client individuality. The CDP participates in ongoing education and stays current with regards to Dementia issues and the National Council of Certified Dementia Practitioners Body of Knowledge. The CDP maintains competence in his chosen profession. The CDP will report to the National Council of Certified Dementia Practitioners any acts by a Certified Dementia Practitioner that is illegal or unethical. The CDP assumes absolute responsibility for your own individual actions. The CDP will stay current with certifications with the National Council of Certified Dementia Practitioners. The CDP insures the privacy of the Dementia client and applies all HIPPA Regulations. The CDP works to implement innovative ideas to the health care setting that may help a Dementia client. The CDP works to ensure that quality of life is provided for the Dementia Clients residing in your health care setting. The CDP networks with other health care professionals, attends Dementia / Alzheimers Seminars, Conventions, Support Groups and Ethics Committees. The CDP respects the Dementia Clients customs, religious beliefs, and philosophy. The CDP is truthful and avoids providing false or misleading Information. The CDP will not use the National Council of Certified Dementia Practitioners on any brochure or advertising without the express permission of this organization and in no way benefit directly or indirectly at the expense of the National Council of Certified Dementia Practitioners. The CDP understands that its certification with the National Council of Certified Dementia Practitioners does not in any way confer upon the CDP any type of licensure as a health care provider. Your Name: (Print) _____________________________________ Date: _______ Your Signature _____________________________________________________ PLEASE COPY FOR YOUR RECORDS. Notary: I, the applicant, certify that I am qualified to make this application for approval for the Certified Alzheimers Disease and Dementia Care Trainer CADDCT certification seminar. I understand that if any of the statements contained in this application and accompanying documents are false or if I fail to comply with this agreement, the NCCDP approval as a Certified Alzheimers Disease and Dementia Care Trainer CADDCT may be terminated and future approval may be denied. ____________________________________________________ ____________ Signature of Instructor: Date: This document must be notarized attesting that the person signing and completing this document is the person completing this document. Only sign in front of a notary. NCCDP Notarization Instructions: The applicant personally appeared and stated upon oath this ________ Day of _______ Month _____Year That the information contained therein is true and correct. Notary Public in and for the state of: _____________________________________________________________________________ Signature of Notary: _____________________________________________________________________________ Name of Notary: _____________________________________________________________________________ Notary Phone Number: ______________________________________________________________________________ Commission Expires; ______________________________________________________________________________ Place Notarization Seal Here: While certification promotes and maintains quality, it does not license, confer a right or privilege upon or otherwise define the qualifications of anyone in the healthcare field. Commonly Asked Questions: When and where is the Certified Alzheimers Disease and Dementia Care Trainer CADDCT Certification Seminar? The dates and locations are posted in several places on the web site. 1. Certified Alzheimers Disease and Dementia Care Trainer Certification CADDCT seminar registration application. Go to the home page. Click instructor and CADDCT registration to download the registration form which lists dates, locations, price and information. 2. On the NCCDP seminar calendar. This seminar tab on the home page will take you to a seminar calendar and there you will find CADDCT Certified Alzheimers Disease and Dementia Care certification trainer seminars that are offered nationwide. The seminar calendar is updated daily. If you do not find the Certified Alzheimers Disease and Dementia Care Certification CADDCT seminar offered in your state, please check back with the NCCDP or contact us. The link to seminar page is  HYPERLINK "http://www.NCCDP.org/calendarix" http://www.NCCDP.org/calendarix. CanNCCDP bring the Certified Alzheimers Disease and Dementia Care Trainer certification seminar to your corporate office and or association state or national conference? Yes, we can bring the Certified Alzheimers Disease and Dementia Care Trainer certification seminar, CDCM Certified Dementia Care Manager (Dementia Unit Managers)and the ADDC Alzheimers Disease and Dementia care seminars to you. This is a cost-effective way to train many staff educatorsvs. the time lost and cost involvedwith travel and time away from work.We will work with you to provide a cost-effective program to fit your needs. Why would this benefit my company to have aCertified Alzheimers Disease and Dementia Care Trainer CADDCT certification? 1. The most important aspect of certification is being confident as a corporation that all of the educatorsare presenting up to date comprehensive Alzheimers Disease and Dementia Care curriculum to your line staff and health care professionals. 2. This shows the public as well as your staff that your companyis committed to Alzheimers Disease and Dementia Care LIVE training by a certified Alzheimers Disease and Dementia Care instructor. Once the staff has completed the training and IF they qualify for CDP certification the staff may submit their application to the NCCDP per the fee noted on the application or the company may elect to invest not only in their training but also CDP certification at a discounted group rate. 3.That you are committed to reducing incidents of abuse and neglect and only through ongoing LIVE / Interactive training is this going to happen. The NCCDP curriculum is designed to keep the professional engaged and interactive so your staff want to learn. 4. That you want to exceed the minimum state requirements for Dementia educationand offer more education. 5. That as a corporation you are sending a clear and loud message to your educators the valueyour companyplaces on comprehensive Alzheimers Disease and Dementia care education.This in turns filters down to your line staff. 6.That your companyrecognizes that video and e-learning isnot the always the best way to present comprehensive Alzheimers Disease and Dementia care education to your front-line staff and health care professionals. Your current method may save you timebut it is not always the best way ensuring your staff understands your commitment to protecting your residents from abuse and neglect through education. This is the old method that is disappearing and more companies are in favor of live interactive training. Which has proven to be more effective than e-learning. In the end, this is a cost-effective curriculum that will save you money and aide in the delivery of care. 7. This is a huge marketing potential for you to let the public know your nurse educators are Certified Trainers by theNational Council of Certified Dementia Practitioners. As well as letting the public know that your line staff received top notch training. Your corporation will be recognized on the NCCDP web site. 8. Associations wishing to bring the CADDCT seminar to your next state or national conference are able to offer your members a reduced rate for the CADDCT raining. At the same time, the NCCDP will also provide the Alzheimers Disease and Dementia Care seminar to your members and they in turn may submit their CDP application to the NCCDP at $35.00 pp vs $125.00 pp. Please contact NCCDP to discuss association rates for the CADDCT seminar and the Alzheimers Disease and Dementia Care seminar. How often is the curriculum updated? The curriculum is updated every two years on an even year. To discuss the benefits of corporate training and or association conference training, please contact us either through email or call us directly for information.  HYPERLINK "mailto:NCCDPCORPORATE@NCCDP.org" NCCDPCORPORATE@NCCDP.org or call 877-729-5191 answering service or 1-973-729-6601 Office staff The office is open M to F 9:00 A.M. to 5:00 P.M. EST. PLEASE SEND BACK THIS ENTIRE DOCUMENT WHEN APPLYING FOR PRE-REGISTRATION FOR THE CERTIFIED ALZHEIMERS DISEASE AND DEMENTIA CARE TRAINER CERTIFICATION CADDCT SEMINAR. Thank you; Lynn Biot Gordon MSW LCSW CADDCT CDP Chief Operations Officer Sandra Stimson CALA AC-BC ADC CDP CADDCT CDCM CDSGF CMDCP COTP Chief Executive Officer Nellie Stolarz BS CALA ADC CDP CADDCT CDCM CFRDT President The Gold Standard in Dementia Education and Certification Why become acertified NCCDP Alzheimers Disease and Dementia Care Trainer CADDCT? 1. A national certification provides the Instructor potential career opportunities and corporate advancement as a certified CADDCT Alzheimers Disease and Dementia Care Trainer. 2. A certified instructor shows yourlevel ofdedication and commitment to not only furthering your education butthe value you place on educationand also your commitment to the health care industry (line staff)and the Dementia patients. 3. Assurance in providing state of the art and up to date NCCDP Dementia education materials. 4. Certainty in knowing you are providingDementia topicsthat have seldom been addressed in health care settings. For example, a topic such assexuality and intimacy is often times a taboo topic and not addressed.You will have the confidence to present materials addressing this topic. 4.Faith that you have an effective method to present to your students. 5. Conviction that you have gained additional knowledge in Dementia care in areas that is not always covered or addressed in traditional seminars, trends, methods, etc. 7. Confidence to provide effective teaching methodsto health care professionals and front line staff that address topics such as;communication, hallucinations, sexuality, repetitive behaviors, wandering, death and dying, etc. 8. Pride that you have met NCCDP national and international standards and generally far exceed the Dementia education requirements by state, federal regulations and international standards that may be mandated for health care professionals. This seminar is taught to health care professionals in a minimum of 8 to 12 hours but can be expanded and adapted to presentfor 20 hours or more, if your country, state or federal requirements requires this. 9. The trainer is confident in skill set. 10. For those who work outside a health care setting, you have the confidence to provide private seminars. Or as you approachretirement, this is an excellent way to earn additional income. 11. If you work in a health care setting or learning institution, this designation and certification will provide additional reasons for career advancement and pay increases which is never a guarantee but certainly you have positioned yourself for career advancement. Thank you for being the best part of the NCCDP CREDIT CARD, Money Order or Check Refund Policy: ONCE WE PROCESSYOUR PAYMENT,THERE IS A$750.00 CANCELLATION FEE. 7 DAYS PRIOR TO THE SEMINAR, IF YOU CANCEL THE SEMINAR, THERE ARE NO REFUNDS. YOU ARE REQUIRED TO PROVIDEWRITTEN CANCELLATIONIN WRITING VIA CERTIFIED MAIL- SIGNED RECEIPT NO LESS THAN 8 DAYS PRIOR TO START OF THE SEMINAR TO BE ISSUED A PARTIAL REFUND. EARLY REGISTRATION: $2500.00 USD PP IF PAYMENT RECEIVED 60 DAYS PRIOR TO THE SEMINAR DATE. LATE REGISTRATION: $2800.00 USD PP IF PAYMENT RECEIVED WITHIN 59 DAYS OF THE SEMINAR DATE. TODAYS DATE: _________________________ CREDIT CARD NAME: CHECK ONE: __VISA __ MASTERCARD ___AX ___DISCOVER NAME ON CARD: _____________________________________________________________ CREDIT CARD NUMBER: ______________________________________________________ EXPIRATION DATE: _____________________________CSV #________________________ THE PERSON WHOSE NAME IS ON THE CARD IS REQUIRED TO SIGN THIS APPLICATION PAGE. ARE YOU REQUESTING ANOTHER CURRICULUM SET IN THE SPANISH LANGUAGE? YES ___ NO ___ Extra curriculum set in another language $175.00 ADDC power point curriculum on memory stick 175.00 instructor manual 25.00 and student handout notebook 25.00. All other products provided in seminar are in English only. Total amount to charge: _______________ I HEREBY GIVE PERMISSION FOR NCCDP TO CHARGE MY CARD IN THE AMOUNT OF $____________________. SIGNATURE OF CARD HOLDER _____________________________________________________________________________ ADDRESS WHERE THE CREDIT CARD BILL IS MAILED TO: NAME: _______________________________________________________________________ COMPANY NAME IF NEEDED: _________________________________________________ ADDRESS: ___________________________________________________________________ CITY: ________ ___________________________ STATE: ____________ ZIP CODE: ________ EMAIL ADDRESS (required): ____________________________________________________ PERSONAL E-MAIL ADDRESS IS MANDATORY. IF YOU DO NOT HAVE A PERSONAL E-MAIL ADDRESS, PLEASE GO TO ANY E-MAIL COMPANY OF YOUR CHOSING SUCH AS AOL, YAHOO, GMAIL, ETC., AND CREATE A FREE ACCOUNT. MOST E-MAIL COMPANIES OFFER A COMPLIMENTARY E-MAIL ACCOUNT. WE WILL NOT PROCESS YOUR APPLICATION WITHOUT AN PERSONAL E-MAIL ADDRESS. YOU CAN NOT USE YOUR SUPERVISOR OR ANOTHER COWORKERS E-MAIL ADDRESS. WE WILL EMAIL YOU A RECEIPT IF YOU REQUEST IT. 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