Biofeedback Recertification Application

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The Biofeedback Certification International Alliance

Application for Biofeedback Recertification

Please complete this form, providing documentation as instructed in each item below. To be considered, applications must include signature and filing fee.

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First   Middle   Last   Professional Designation (optional)  (This information will be printed on your certificate.)

License/Credential for Independent Practice

When treating a medical or psychological disorder, you are required to hold a current health care license/credential or agree to work under the supervision of an appropriately credentialed  health care professional. This credential in a BCIA approved health care field must be issued or recognized by the state in which you practice.

If you do not have an electronic copy of the above documents, you may fax it to (303) 422-8894 or mail to the address below, in the web footer.

I am applying for recertification by Continuing Education (CE).
I attest to the completion of 48 hours of accredited CE (including 3 hours of ethics) in the past 4 years.
All hours must be blueprint-relevant topics.

I am applying for recertification by the successful completion of the written certification exam.
I will contact BCIA to make specific arrangements, allowing at least 2 weeks for scheduling,
and will pay an additional $50 fee plus any fees incurred for using the special exam option.

Procedures: The candidate must
a) complete and sign the application;
b) attest to completion of 48 hours of accredited CE;
c) agree to abide by BCIA's Professional  Standards and Ethical Principles of Biofeedback (PSEP); and
d) include all appropriate fees according to the schedule below:

January 1 - June 30: $225     July 1 - October 31: $250     After November 1: $275

2nd recertification:     January 1 - June 30: $175     July 1 - October 31: $200     After November 1: $225

Audit: Ten percent of all applications will be audited. The candidate will be notified requesting a CE log with copies of proof of course completion to be submitted within 30 days. If there is no response to our request for documentation, the application will be considered incomplete and it will be withdrawn. If an application is incomplete or withdrawn, a $75 administrative fee will be charged and the balance of the recertification fee will be refunded. BCIA’s lapsed recertification program may then be used to reinstate your certification.

Attestation: I hereby attest that I have completed BCIA requirements towards recertification in biofeedback, i.e., accredited continuing education hours from any of the blueprint areas over the past four years or successful completion of the written exam. By attesting to the above requirements, I agree to provide all necessary documentation if my application is selected by BCIA for audit. I understand recertification will not be allowed unless I am able to document the requirements as requested.

Agreement

1. I, the undersigned, do hereby make voluntary application to the Biofeedback Certification International Alliance – formerly the Biofeedback Certification Institute of America (BCIA). I certify that the information given by way of this application is true, honest, and completely represents me.

2. I will conform to all applicable local, state, and federal regulations and conduct myself consistent with the highest standards relating to my profession and specialty.

3. I have read and agree to be bound by the BCIA Professional Standards and Ethical Principles of Biofeedback (PSEP) and their policies and procedures. I understand that the PSEP and any BCIA policies and procedures may be amended from time to time and that I am bound by these documents as amended. I also understand that in accordance with such policies and procedures:

(a) the final determination of any dispute arising between me and BCIA will be made by its board of directors and that I will be bound by the board’s determination and may not seek review;

(b) however, if grounds exist that would permit a court to overturn or modify the board’s determination or otherwise act in the matter, that I will seek redress only in Denver, CO and only by arbitration in accordance with such policies and procedures; and

(c) because I have agreed that the board’s determination is final and binding upon me, I am likely to be required to pay the costs, reasonable attorney fees and other expenses of BCIA in any proceedings instituted by me.

4. I understand and agree that BCIA and its affiliates assume no responsibility for my actions or activities. I practice at my own risk and hereby release BCIA from any and all liability from any practice decisions I make.

5. I hereby give permission to BCIA to contact individuals or agencies listed for verification of information submitted. I recognize that failure to do so may result in disciplinary action including suspension or revocation of my certification.

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