Thank you for connecting with us, we will respond to you shortly 11https://coebo.com/wp-content/plugins/nex-forms-express-wp-form-builderhttps://coebo.com/wp-admin/admin-ajax.phphttps://coebo.com/senate-application1fadeInfadeOutdefaultH3BOCB Senate Application Divider Full NameFull NameHelp text... Date of ApplicationDate of ApplicationHelp text... E-mail AdressE-mail AdressHelp text... Phone #Phone #Help text... Mailing addressMailing addressHelp text... CityCityHelp text... StateStateHelp text... Zip CodeZip CodeHelp text... H2 BACB Certification Information Divider Level of CertificationLevel of CertificationBCaBABCBABCBA-DHelp text... Other (Please specify)Other (Please specify)Help text... BACB Certification NumberBACB Certification NumberHelp text... Time since Certification acquiredTime since Certification acquiredHelp text... Do you provide supervision for individuals seeking Certification ?Do you provide supervision for individuals seeking Certification ?Help text... H2Employment Information Divider Current employerCurrent employerHelp text... Employer addressEmployer addressHelp text... How long?How long?Help text... CityCityHelp text... StateStateHelp text... Zip codeZip codeHelp text... PhonePhoneHelp text... E-mailE-mailHelp text... PositionPositionHelp text... How long?How long?Help text... H2Employment Information Divider Current employerCurrent employerHelp text... Employer addressEmployer addressHelp text... How long?How long?Help text... CityCityHelp text... StateStateHelp text... Zip CodeZip CodeHelp text... Phone Phone Help text... E-mailE-mailHelp text... PositionPositionHelp text... How Long?How Long?Help text... H2Additional Organizations You Represent Divider Organization(s)Organization(s)Help text... Position(s) heldPosition(s) heldHelp text... H2Education Divider Bachelor's Degree InformationBachelor's Degree InformationHelp text... InstitutionInstitutionHelp text... Graduation yearGraduation yearHelp text... CityCityHelp text... StateStateHelp text... Master's Degree Information (if applicable)Master's Degree Information (if applicable)Help text... InstitutionInstitutionHelp text... Graduation yearGraduation yearHelp text... CityCityHelp text... StateStateHelp text... PhD Degree Information (if applicable)PhD Degree Information (if applicable)Help text... InstitutionInstitutionHelp text... Graduation yearGraduation yearHelp text... StateStateHelp text... CityCityHelp text... Are you currently in pursuit of an additional degree?Are you currently in pursuit of an additional degree?Help text... DividerH2Notable Involvements/Accomplishments within the field DividerH3Please list and explain notable involvements/Accomplishments within the field here: Text AreaText AreaHelp text...H2References Divider NameNameHelp text... E-mail AddressE-mail AddressHelp text... PhonePhoneHelp text... DividerH2Eligibility Requirements and Attestation Divider ParagraphIn order to be eligible for a position on the BOCB Senate, the following requirements must be met: Paragraph• One year of experience in an administrative and/or clinical supervisory position • The candidate must provide an updated copy of their Curriculum Vitae • A one page Letter of Intent must be submitted addressing the following questions: Paragrapho What interests you about the BOCB? o What skills do you believe you can bring to the role of being a BOCB Senate member? o What are your primary areas of interest and proficiencies within the field that will aid in contribution to the BOCB? Paragraph• Candidate must submit suggestions for the BOCB proposal. (Using Track Changes on Microsoft Word) • In order to be considered for a position on the BOCB Senate, candidate must undergo an interview with a current BOCB member. ParagraphAttestation: Paragraph• Senate Member must remain in good standing with their BACB Certification. • All Senate Members are expected to uphold the COEBO Standards within their place of business. • Senate Member must attend all monthly meetings. o Members will be notified of said meetings at least 48 hours in advance. • Term will be one year for the inaugural board.H2Signature Divider ParagraphI confirm that all information stated above is true and I authorize the verification of the information provided on this form in order to be considered for a position in the Behavioral Organization Certification Board. Signature of applicantSignature of applicantHelp text... DateDateHelp text... Curriculum VitaeCurriculum Vitae doc docx mpg mpeg mp3 odt odp ods pdf ppt pptx txt xls xlsx Help text... Letter of IntentLetter of Intent doc docx mpg mpeg mp3 odt odp ods pdf ppt pptx txt xls xlsx Help text... BOCB Proposal SuggestionsBOCB Proposal Suggestions doc docx mpg mpeg mp3 odt odp ods pdf ppt pptx txt xls xlsx Help text... Submit ButtonSubmit Powered by NEX-Forms