ASSOCIATION OF CHRISTIAN ALCOHOL & DRUG COUNSELORS INSTITUTE
P.O. Box 8604, Redlands CA 92375
(877) 478-5756 • Fax: (866) 862-6805
Email: acadc@acadc.org • Website: www.acadc.org
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 _________________
HOW DID YOU HEAR ABOUT US? _________________________________________
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 & fees.
Rev 08/08
