Council on Professional Standards for Kinesiotherapy (COPS-KT)
2018 Continuing Competency Form

Due June 30, 2018: PLEASE ALLOW 2-4 WEEKS FOR PROCESSING

CURRENT STATUS

Continuing Education Units (CEU'S) Due for 2018: 0
Continuing Competency Fee Due:

Before July 1, 2018 $

After July 1, 2018 $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
    • Use this link for payment: https://akta.org/product-category/registration-fees
    • 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: Melissa Ziegler 118 College Drive #5142 Hattiesburg, MS 39406
  • Payment and CEU verification must be submitted by June 30, 2018. A response to this application is required of those who wish to remain in "good standing". Those who do not provide both proof of education and payment by June 30, 2018 will be placed on Probation. Revocation of registration will occur following three consecutive years of probationary status.

    Questions? Contact Bridget Collins: email ccbkt@akta.org or call 800-296-AKTA