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ASSOCIATION
OF CHRISTIAN ALCOHOL & DRUG COUNSELORS INSTITUTE
P.O.
Box 8604, Redlands CA 92375
(877)
478-5756 • Fax: (866) 862-6805
APPLICATION
FORM
Submit
your registration and CSAC I Exam fee, (check or money order) made
payable to: ACADC in the amount of $330. This fee includes
your registration with ACADC as your chosen certification organization, your
CSAC I Exam, and your CSAC I Certification Fee. Also check the boxes below and
include the amounts for each additional course or program for which you are
enrolling. Mail it to: ACADC Institute, ATTN: Registration
Office, P.O. Box 8604, Redlands, CA 92375.
NAME
(FIRST - MIDDLE - LAST)___________________________________________
ADDRESS_________________________CITY____________STATE____ZIP_______
DAY
PHONE __________________ ATLERNATE PHONE ____________________
EMAIL
_____________________________ SSN (Last 4 Digits)
_____ _____ _____
_____
DATE
OF BIRTH ___________________ INSTITUTE LOCATION: ___VINELAND,
NJ ____
HOW
DID YOU HEAR ABOUT US? ____ Acquire
the Legacy Counseling/Training Center
____
HAVE
YOU EVER HAD AN AOD CERTIFICATION REVOKED OR SUSPENDED? (PLEASE EXPLAIN - use
an additional sheet of paper if needed)
ARE
YOU A 290 OFFENDER? [ ] Yes [
] No
CREDENTIAL
PROGRAMS AND TUITION FEES
(Please
check the program(s) or course(s) for which you are registering):
[
]
CSAC
I Entrance Inventory -
Certified Substance Abuse Counselor CSAC I Designation - Exam Fee:
$330 (Includes fee for California Department of Alcohol and Drug program
registration - ACADC Membership - Test Booklet and CSAC I Certificate)
[
]
CSAC
II -
Verification of 160 hours of Direct Supervision and 2080 hours of Field
Experience - Fee: $330
[
]
Certified
Drug, Alcohol & Addictions Counselor Certification (CDAAC)
- 155 classroom hours required for state certification -
Tuition $1540
[
] Certified Drug, Alcohol & Addictions Counselor
Certification (CDAAC) - (For applicants with transcripts meeting
the requirements) - Tuition $1020 (Requires the CSAC I & II
[
] Reciprocity from another in-state certifying
organization - $330
[
] Reciprocity from an out-of-state
Certification - $990
[
] Combination CSAC I, CSAC II, and CDAAC -
Tuition & Fees: $2200 (CSAC I, II, and CDAAC required for State
certification through the Department of Alcohol and Drug Programs
[
] Master level CDAAC M – (Requires a degree and a written
paper discussing TAP 21 from a Christian Worldview) – Certification Fee:
$330
[
] Board Certified Drug, Alcohol & Addictions Counselor – (Requires
a Bachelors Degree or higher, a written work discussing TAP 21 from a
Christian Worldview, and an oral interview) – Certification Fee: $330
[
]
Transcript
Review - $30
[
]
ACADC
Institute Charter and Administrator Certification
- Tuition: $1500
RELATED
CERTIFICATIONS
[
]
Lay
Minister/Counselor Certification
- One day workshop - Tuition:$330
[
]
Anger
Management Instructor
- One day workshop - Tuition: $330
[
] Youth
Anger Management Instructor - One day workshop - Tuition:$330
[
] Domestic
Violence Prevention Instructor – one - day workshop - Tuition:$330
[
] Addictions
Interventionist - One day workshop - Tuition: $330
[
] Motivational
Interviewing Certification - One day workshop - Tuition: $330
[
] ASI
Administrator Certification - One day workshop - Tuition: $330
[
] Suicide
Interventionist - One day workshop - Tuition: $330
[
] PTSD
Counseling Certification - One day workshop - Tuition: $330
[
] Christian
Marriage & Family Counselor Certification - $995
[
] Parenting
Instructor - One day workshop - Tuition: $330
[
] Residential
Facility Counselor Certification - One day workshop - Tuition: $330
ACADC
INSTITUTE COLLEGE DEGREE PROGRAMS
[
] Associate
of Ministry Degree in Christian Drug, Alcohol & Addictions Counseling
- Tuition: $660
[
] Bachelor
of Ministry in Christian Drug, Alcohol & Addictions Counseling, -
Tuition: $1200
[
] Master
of Ministry in Drug, Alcohol & Addictions Counseling, M. Min. -
Tuition: $2500
[
] Master
of Divinity in Pastoral Counseling, M.Div.
- Tuition: $2500
[
]
Doctor
of Ministry in Christian Counseling, D. Min.
- Tuition: $3500
[
]
Doctor
of Divinity in Pastoral Counseling, D.Div
- Tuition: $3500
Call
877-478-5756 for further information
I
understand that the certifications and degree programs for which I am hereby
enrolling are granted under the authority of the Association of Christian
Alcohol & Drug Counselors and will be subject to the Association's
ethical standards described in it's code of conduct. I understand that
upon completion of all program requirements, the certification or degree for
which this application is made will be granted. I acknowledge that all
tuition & fees paid go to the work of the Association of Christian
Alcohol & Drug Counselors and are non-refundable. I understand that
in addition to classroom attendance, it is my responsibility to know and meet
all state requirements for certification. I agree to take no legal action
against the Association of Christian Alcohol & Drug Counselors or any
individual minister, counselor, educator or employee associated with the
Association of Christian Alcohol & Drug Counselors.
Student’s
Signature: _____________________________________________________________
Dated
on the _________ day of the month of ______________________, 2008.
I
am including a check or money order made payable to ACADC in the amount of: $_____________________
Please consult above checklist for your total tuition fee.
Rev
05/08