Council on Professional Standards for Kinesiotherapy(COPS-KT)
2017 Continuing Competency Form

Due June 30, 2017: PLEASE ALLOW 2-4 WEEKS FOR PROCESSING

CURRENT STATUS

Continuing Education Units (CEU'S) Due for 2017: 0
Continuing Competency Fee Due:

Before July 1, 2017 $

After July 1, 2017 $50

PRIMARY PERSONAL INFORMATION

  • Cert#: -
  • Name: -
  • Address: -
  • City: -
  • State: -
  • Zip: -
  • Primary Phone #:-
  • Email:

AGENCY INFORMATION

  • Agency Name: -
  • City:-
  • State:-
  • Alternate Phone#:-

Contact Information

Employer Information

Provide Continuing Education Credits(ensure each certificate is prepared and authenticated by the Sponsor for each course completed). Education credits must relate to the Scope of Practice for Kinesiotherapy. Examples include:
  • Undergraduate or Graduate course-work (with copy of course transcript)
  • Workshops or conferences attended (with certificate of attendance)
  • Lectures given (with copy of course objectives and verification of date)
  • Home study courses(pre-approved by COPSKT)
Payment and submission options (choose one)
  • 1. Payment by Credit Card and submit CEUs via email
    • Make credit card payment at akta.org under My Payments
    • Email THIS APPLICATION and CEU verification to Email ccbkt@akta.org. All materials should be attached to ONE email message.
  • Applications MUST be submitted with CEU verification, NO EXCEPTIONS.
  • 2. Payment by check /money order and submission by mail
  • Return Application, payment, and CEU verification to: CCB-KT P.O. Box 1390 Hines, IL 60141-1390
  • Payment and CEU verification must be submitted by June 30, 2017. A response to this application is required of those who wish to remain in "good standing". Those who do not respond by June 30, 2017 will be placed on Probation. Revocation of registration will occur following three consecutive years of probationary status.

    Questions? Email ccbkt@akta.org or call 800-296-AKTA