Contact Information

PERSONAL

* Required Field

* First Name

* Last Name

* Street 1

Street 2

* City

* State

* Zip Code

* County of Residence

If you do not live in NJ, pick the NJ county closest to your home.

* Primary Phone

* Primary E-mail:

* Confirm Primary E-mail:

* I identify my gender as:

Female
Male
Gender non-confirming
Prefer to describe
Prefer not to answer

* Preferred Pronouns:

She/her/hers
He/Him/His
They/Them/Theirs
Prefer to describe

Age

Ethnicity

WORK

* Required Field

* Are you currently:

Unemployed
Employed/volunteer at a Division of Mental Health and Addiction Services (DMHAS) treatment or mental health agency
Employed at another type of organization or company

* Are you currently:

Employed/volunteer at a Division of Mental Health and Addiction (DMHAS) Substance Use Disorder treatment (SUD) agency with a proposed plan of supervision
Employed/volunteer at a Division of Mental Health and Addiction (DMHAS) Substance Use Disorder (SUD) treatment agency without a proposed plan of supervision
None of the Above Apply

Provisional – Maximum of five (5) course scholarships through NJPN. Masters in related field required. Provisionals are individuals interested in pursuing an internship at a DMHAS-licensed substance abuse treatment agency but have not yet been hired as an alcohol and drug counselor intern.
CDA – Nine (9) specific courses for CDA certification. CDA is designed for the individual working toward a career as a Counselor in a licensed alcohol and drug treatment facility. GED/HS Diploma, Associates, Bachelors, or Masters degrees in an unrelated field acceptable.

Please attach your resume here

Browse…

* Employment Time:

Part-Time
Full-Time

* Number of Years with Agency:

* Employer Name

Program

Position/Title

* Street 1

Street 2

* City

* State

* Zip Code

* Phone

Extension

* E-mail (If you do not have a business email, enter your personal email.)

All communication is done via e-mail, so either a home or work e-mail address is required.

* Salary (must include your total reported annual earnings):

* Do you work primarily in the substance abuse treatment unit at a DMHAS-licensed agency?

Yes
No

* Do you work primarily in the mental health unit at a DMHAS-licensed agency?

Yes
No

* Do you work at a state psychiatric hospital?

Yes
No

* Are you a state employee?

Yes
No

* Are you a state contractor?

Yes
No

Clinical Supervisor's Information

* Supervisor's Last Name

* Supervisor's First Name

* Supervisor's Title

* Supervisor's E-mail

* Supervisor's Credentials

* Supervisor's Phone

Experience and Education

* Required Field

* How many experience hours towards the 3000 required for the CADC/LCADC have you completed?

* Please select the highest level of education that you have achieved

High School Diploma

GED

2 Year College

4 Year College

Masters

PhD

Field of Study

* Do you currently possess any counseling or human service related certificates and/or licenses?

Yes
No

If so, please list type of license/certificate and approval number.

Transcript Review
If you have taken courses or have a degree in counseling, social work or a related field and you have had your transcript(s) reviewed by the Addiction Professionals Certification Board, please attach a copy of your review letter here so we can verify which of the CADC courses you need to take to complete your LCADC/CADC coursework. You must also indicate all courses not appearing on your Certification Review letter as ALREADY COMPLETED in course index field below.

ONLY the one-page Certification Board Review letter should be uploaded in this area (all other uploads will cause a delay).

If you have a Master’s degree in a related field and have not had your transcript reviewed by the Certification Board, please visit http://www.certbd.org for more information.

Please attach your Certification Board Letter here

Browse…

Please check the courses which you have ALREADY COMPLETED:

Courses available PRIOR to July 1, 2007:	Courses available AFTER July 1, 2007
C101A - Initial Interviewing Process		C101 - Initial Interviewing	C101 - Initial Interviewing - 6 hours		C401 - Addiction Recovery	C401 Addiction Recovery – 6 hours
C101B - Initial Interviewing Process		C102 - Biopsychosocial Assessment	C102 Biopsychosocial Assessment – 12 hours		C402 - Psychological Client Education	C402 Psychological Client Education – 6 hours
C101C - Initial Interviewing Process		C103 - Diagnostic Summaries	C103 Diagnostic Summaries – 12 hours		C403 - Biochemical/Medical Client…	C403 Biochemical/Medical Client Education – 18 hours
C102A - Biopsychosocial Assess…		C104 - Differential Diagnosis (DSM)	C104 Differential Diagnosis – 12 hours		C404 - Sociocultural Client Education	C404 Sociocultural Client Education – 6 hours
C102B - Biopsychosocial Assess…		C105 - Pharmacology and Physiology	C105 Pharmacology and Physiology – 6 hours		C405 - Addiction Recovery and Family Psych. Educ.	C405 Addiction Recovery & Family Psychological Education – 6 hours
C102C - Pharmacology		C106 - Perinatal/Fetal Alcohol Spectrum Assessment	C107 Compulsive (Disordered) Gambling – 6 hours		C406 - Biochemical and Sociocultural Family Educ.	C406 Biochemical and Sociocultural Family Education – 6 hours
C103A - Diagnostic Summaries		C107 - Compulsive Gambling			C407 - Community and Professional Education	C407 Community and Professional Education – 6 hours
C103B - Diagnostic Summaries		C108 - Co-Occurring Disorder Assessment			C408 - Opiate and Stimulant Education
C104 - Compulsive Gambling		C109 - Assessment Tools			C409 - Alcohol, Sedative and Hallucinogens

C201A - Introduction to Counseling		C201 - Introduction to Counseling	C201 Introduction to Counseling – 6 hours	>	>C501 - Ethical Standards	C501 Ethical Standards – 6 hours
C201B - Introduction to Counseling		C202 - Counseling Skills (Introduction to Techniques)	C202 Counseling Skills – 6 hours		C502 - Legal Aspects	C502 Legal Standards – 6 hours
C202 - Introduction to Techniques…		C203 - Crisis Intervention	C203 Crisis Intervention – 6 hours		C503 - Cultural Competency	C503 Cultural Competency – 6 hours
C203 - Crisis Intervention		C204 - Addiction Focused Counseling (Individ. Counseling)	C204 Addiction Focused Counseling – 18 hours		C504 - Professional Growth	C504 Professional Growth – 6 hours
C204A - Individual Counseling		C205 - Group Counseling	C205 Group Counseling – 6 hours		C505 - Personal Growth	C505 Personal Growth – 6 hours
C204B - Individual Counseling		C206 - Family Counseling	C206 Family Counseling – 12 hours		C506 - Dimensions of Recovery	C506 Dimensions of Recovery – 6 hours
C205A - Group Counseling		C207 - Cognitive Behavioral Therapy			C507 - Supervision	C507 Supervision – 6 hours
C205B - Group Counseling		C208 - Motivational Interviewing / Motivational Enhancement Therapy			C508 - Community Involvement	C508 Community Involvement – 6 hours
C206 - Family Counseling		C209 - Pharm. Approaches to Nicotine Dependencies			C509 - Consultation	C509 Consultation (Professional Standards) – 6 hours

C301A - Community Resources		C301 - Community Resources	C301 Community Resources – 18 hours
C301B - Community Resources		C302 - Consultation	C302 Consultation (in Case Management) – 18 hours
C301C - Community Resources		C303 - Documentation	C303 Documentation – 12 hours
C30A - Consultation		C304 - HIV & Resources	C304 HIV and Resources – 6 hours
C302B - Consultation		C305 - New Jersey Mental Health Services
C302C - Consultation		C306 - New Jersey Child and Family Services
C303A - Documentation		C307 - Criminal Justice System
C303B - Documentation		C308 - New Jersey Disability Services
C304 - HIV-Positive Resources		C309 - New Jersey Employment Services

C401 - Addiction Recovery
C402 - Psychological Client Education
C403 - Biochemical/Medical Client…
C404 - Sociocultural Client Education
C405 - Addiction Recovery and…
C406 - Biomedical/Sociocultural…
C407A - Community & Professional…
C407B - Community & Professional…
C407C - Community & Professional…

C501 - Ethical Standards
C502 - Legal Aspects
C503A - Cultural Competency
C503B - Cultural Competency
C504 - Professional Growth
C505 - Personal Growth
C506 - Dimensions of Recovery
C507 - Supervision & Consultation
C508 - Community Involvement

If you have taken courses in the topics listed above at an accredited college or university, you may want to contact the Certification Board who will determine if Section 3: Select Your Preferred Training Location * for more information.

Select Your Preferred Training Location

* *CURENTLY ALL WEEKLY COURSES ARE HELD VIRTUALLY THROUGH ZOOM* Please select the day you are available to attend class. Indicate your first choice. (Select a second choice only if the day of the week are viable options for you.)

Willing to travel to any site, any day of the week.

* Do you have access to a webcam, (computer, laptop, Chromebook, tablet) available to be able to engage in Virtual Learning?

Yes
No

* Do you have internet connection/WIFI?

Yes
No

* Do you have capability to download zoom for remote learning?

Yes
No

How did you learn about the Addiction Training and Workforce Development Program?

Internet Search

Coworker

Friend

NJPN Magazine

NJPN Annual Conference

Other

Student Statement

* In your own words, please tell us why you should be selected for the Training and Workforce Development Initiative Scholarship program. Include the reason(s) you desire a career in the addictions field and include how the course work will lead to your obtaining your CADC or LCADC.

If you are not CURRENTLY working at a DMHAS-licensed substance abuse treatment or mental health agency or a state psychiatric hospital, please explain what plans you are currently making to secure an internship in order to complete the required 3,000 experience hours needed for certification or licensure.(If you do not fully respond to this inquiry in your Statement, your Application will be delayed.)

Agreements

* I agree to give NJPN the authority to access the results of the LCADC/CADC written and oral exam in order to monitor my progress towards certification or licensure as an alcohol and drug counselor. I understand that NJPN will not publish test results but rather will use this information to evaluate the success of students in the Addiction Training and Workforce Development Program as compared to other CADC candidates who have not received training through NJPN.

* By checking this box, I attest that the information I have supplied is true to the best of my knowledge.

Summary Information

New Jersey Prevention Network
Addiction Training and Workforce Development
Program Student Application

Please note: The information supplied populates your profile in our database. Please proofread carefully before submitting. Incomplete applications that do not meet this criteria cannot be processed.

Your application is not complete!

Thank you for submitting your application.

In order to complete and review your application you must download and email/fax the CSC form below, along with a copy of the letter from Division of Consumer Affairs – Alcohol & Drug Counselor Committee (DCA-ADCC), indicating your Proposed Plan of Supervision was reviewed and approved by DCA-ADCC (See image below).

Clinical Supervisor Confirmation Form

Sample Letter

NJPN will email you shortly with additional information once your application is reviewed in its entirety.

New Jersey Prevention Network
Addiction Training and Workforce Development
Program Student Application

Thank you for submitting your application.

NJPN will email you shortly with additional information once your application is reviewed in its entirety.

New Jersey Prevention Network Addiction Training and Workforce Development Program Student Application

Contact Information

PERSONAL

WORK

Experience and Education

Select Your Preferred Training Location

How did you learn about the Addiction Training and Workforce Development Program?

Student Statement

Agreements

Summary Information

New Jersey Prevention Network Addiction Training and Workforce Development Program Student Application

Your application is not complete!

New Jersey Prevention Network Addiction Training and Workforce Development Program Student Application

New Jersey Prevention Network
Addiction Training and Workforce Development Program Student Application

New Jersey Prevention Network
Addiction Training and Workforce Development
Program Student Application

New Jersey Prevention Network
Addiction Training and Workforce Development
Program Student Application