73 Valley Drive Furlong, PA 18925 800-553-7678  800-633-7223  FAX215-794-3386  www.pace411.com

IMPORTANT! There is a "Grandfathering Period" in effect until April 30, 2010. During this period, "Application Processing Fees" will be reduced by 50% and the required documentation needed for certification will be at a minimum.

PACE APPLICATION

Nationally Certified Parenting Coordinator™ (NCPC) PACE, as a recognized professional organization, certifies qualified mental health professionals to practice the mental health specialty of Parenting Coordinator at the independent practice level. They will hold the credential of Nationally Certified Custody Evaluator™(NCCE) What is a Parenting Coordinator? The use of Parenting Coordinators is a relatively new intervention to manage high-conflict custody cases. Parents retain and compensate a clinician to arbitrate ongoing child-related disputes either by private agreement or by Court Order. That clinician then becomes the Parenting Coordinator. What does the Parenting Coordinator do? The Parenting Coordinator works directly with the parents to help them communicate more effectively and avoid conflicts about child-related issues. Parents who are constantly in court about child-related issues (such as a holiday visitation schedule or the sharing of information about a child’s academic or medical developments) might benefit from opinions and guidance to help make communication more effective. In addition, the parenting coordinator mediates issues, and when the parents are unable to agree, the parenting coordinator is often given the power to arbitrate what the result should be. Ultimately, the court has the final say over child custody and visitation issues, but a Parenting Coordinator can drastically reduce the need to go to court and therefore reduce conflict for the children in families involved in such disputes. Members will have a document to verify their certification. The certification document is a license-sized certificate (8” X 5”) with special built-in security characteristics. It contains all of the relevant information and attests to the fact that the named recipient is “Certified to practice as a Parenting Coordinator at the independent practice level.” Additionally, court personnel and prospective clients will be invited to visit a new website, being developed as both a registry and also to enhance the credibility and stature of the Nationally Certified Parenting Coordinator™(NCPC).

Criteria for Certification Nationally Certified Custody Evaluator™ (NCCE) Nationally Certified Parenting Coordinator™ (NCPC) 1. Doctoral or Masters Degree in a mental health specialty from a university/college that is regionally accredited; and 2. One of the following: • Currently licensed by a State Board of Examiners to practice a mental health specialty at the independent practice level and/or • Member of a recognized mental health professional association that has promulgated relevant standards of practice for a mental health specialty and/or • Minimum of two years experience working for a family court system; and 3A. Certified Custody Evaluator™(NCCE) A minimum of two years custody evaluation experience, during which the applicant has independently conducted a minimum of five comprehensive custody evaluations; and 3B. Nationally Certified Parenting Coordinator™(NCPC) A minimum of two years experience working at a professional level with at least five sets of high conflict or litigating parents, providing services that have been described by various designations, including, but not limited to: parental coordinator, parenting coordinator, family coordinator, mediator, reunification therapist, etc.; and 4. Two Endorsement Memos (See the Application that follows); and 5. Renewal occurs every twelve months. Six contact hours of continuing education courses relevant to Custody Evaluator and/or Parenting Coordinator is required for renewal.

FEES Nationally Certified Custody Evaluator™ (NCCE)    ONE-TIME APPLICATION PROCESSING FEE: $200   $100 until April 30, 2010    YEARLY CERTIFICATION FEE: $198 Nationally Certified Parenting Coordinator™ (NCPC)    ONE-TIME APPLICATION PROCESSING FEE: $200   $100 until April 30, 2010     YEARLY CERTIFICATION FEE: $198 BOTH CREDENTIALS AT THE SAME TIME: Nationally Certified Custody Evaluator™(NCCE) and Nationally Certified Parenting Coordinator™(NCPC)    ONE-TIME APPLICATION PROCESSING FEE: $300  $150 until April 30, 2010    (Total for both certifications)    YEARLY CERTIFICATION FEE: $298    (Total for both certifications)

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PACE APPLICATION Name_________________________________________________________________ Degree/Title __________________________________________________________ Please show us above EXACTLY how you want your name and degree/title to be printed on your certification credential for Nationally Certified Custody Evaluator™(NCCE) and/or Nationally Certified Parenting Coordinator™(NCPC). OFFICE ADDRESS: BUSINESS NAME:_____________________________________________________________ STREET ADDRESS ___________________________________________________________ _____________________________________________________________________________ CITY_______________________________________________STATE_______ZIP__________ RESIDENCE ADDRESS: (optional) Street_____________________________________________________________________ __________________________________________________________________________ CITY________________________State_______ ZIP/Postal Code________________ Preferred Mailing Address: [ ] Office [ ] Residence What geographical area do you cover with the services that you offer? ______________________________________________________________________ ______________________________________________________________________ TELEPHONE: Office: ( ______ ) ____________________ FAX ( ______ ) __________________ Residence: ( ______ )________________ EMAIL _______________________________ I am licensed in the state(s) of: ____________________________ as a _________________________________ ____________________________ as a _________________________________ ____________________________ as a _________________________________ Please enclose a photocopy of your license(s). COURT EMPLOYEES: please enclose a letter, on court letterhead, verifying that you are a court employee. I am presently a member in good standing of a professional organization that represents my mental health discipline. Please provide name(s) below: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Place a “C” in parentheses after any organization above that certifies its members to practice a mental health specialty at the independent practice level. Have you ever been found guilty of malpractice or charged with an ethics violation that resulted in censure, suspension, probation or revocation of your license? [ ] YES [ ] NO If YES, what is the present status of your license? (Additional documentation is welcome) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ POST SECONDARY EDUCATION: Institution                      Years Attended                      Major                Degree             Year Awarded _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Are you listed in the National Register of Health Service Providers?   [ ] YES   [ ] NO If YES, please send us a photocopy of the full page where you are listed. Please send us a copy of your latest and most complete CV. Please underline anything that you believe particularly qualifies you for the certification(s) for which you are applying (pre- or post-degree educational courses, supervised training, seminars, mediation experience, etc.) Please list any workshops or seminars that you have attended or given that would add to your knowledge base as a Nationally Certified Custody Evaluator™(NCCE) and/or a Nationally Certified Parenting Coordinator™(NCPC). Please list specific books you have read that you believe add to your qualifications. (Please include the full title and author.) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ (Additional sheets can be used. Supporting documents can be included.) [ ] I am applying for: Nationally Certified Custody Evaluator™(NCCE) I understand that I am required to have a minimum of two years custody evaluation experience, during which the applicant has independently conducted a minimum of five comprehensive custody evaluations I have conducted approximately ______comprehensive custody evaluations over a period of ______years. [ ] I am applying for: Nationally Certified Parenting Coordinator™(NCPC) I understand that I am required to have a minimum of two years experience working at a professional level with at least five sets of high conflict or litigating parents, providing services that have been described by various designations, including, but not limited to: parental coordinator, parenting coordinator, family coordinator, mediator, and reunification therapist. I have worked at a professional level with approximately _______sets of high conflict or litigating parents as described above over a period of _______years.

ENDORSEMENT MEMOS Each Applicant must submit one Endorsement Memo. (It can accompany your Application or be mailed separately.) Please request Endorsement Memos from colleagues (mental health professionals, attorneys, judges, court personnel, mediators, etc.) who have knowledge of your experience. Applicants should choose colleagues who can comment (in general) on your career as a mental health professional and (specifically) as to the number of custody evaluations you have completed and/or the number of sets of parents for whom you have provided custody coordination services. EXAMPLE:

I hereby make voluntary application to be certified as a: [ ] Nationally Certified Custody Evaluator™ (NCCE) [ ] Nationally Certified Parenting Coordinator™ (NCPC) I have reviewed the CRITERIA for CERTIFICATION and I attest to the fact that my training and experience qualifies me to be certified under the credential(s) for which I am applying. Upon registration I agree that I am bound by the ethics of my mental health profession, by the state in which I am licensed (or the court where I am employed) and by any relevant standards of practice which may be adopted from time to time by PACE. I agree to notify PACE of any changes in this application. I authorize the exchange of information concerning this application with any professional societies or membership groups, any state licensing or certifying authorities, any educational institution, any court system, and any individuals or groups that, in the opinion of PACE, are relevant to the verification process of this application. Signature__________________________________________Date___________

APPLICATION CHECKLIST [ ] Have you enclosed a photocopy of your current license? [ ] Court employees only: Have you enclosed a letter from the court certifying your status as an employee? [ ] If you are listed in the National Register of Health Service Providers have you enclosed a photocopy of the page where you are listed? [ ] Have you enclosed your latest and most complete CV? [ ] Have you requested (or enclosed) two Endorsement Memos? [ ] Is the application completed and signed? [ ] Have you enclosed the application processing fee and the first year certification fee?              [ ] Check  (Payable to PACE)       [ ] Credit Card CREDIT CARD INFORMATION: [ ] VISA [ ] MC [ ] Amer. Exp [ ] Discover NAME: _________________________________________ CARD #: _______________________________________ EXPIRATION: (month/year) _____/______ AMOUNT BEING CHARGED: $______________

MAIL EVERYTHING TO:

PACE
73 VALLEY DRIVE
Village of Furlong, PA 18925

OR FAX EVERYTHING TO:

215-794-3386

QUESTIONS? 800-553-7678 or staff@vp411.com