NCPC Application - Monthly

I AM APPLYING FOR NATIONALLY CERTIFIED PARENTING COORDINATOR:

I certify that I have a minimum of two years of 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: parenting coordinator, family coordinator, mediator, reunification therapist, couples therapy, marriage counseling, facilitator, etc.
(NOTE: PACE is seeking professionals who have experience working with couples who are in conflict with each other.)

Name

Please show us EXACTLY how you want your name to be printed on your certification credential

First Name

Last Name

Degree/Title

Please show us EXACTLY how you want your degree/title to be printed on your certification credential

Contact Information

Business Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

What geographical area do you cover with the services that you offer?

Work Phone

Country

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Fax

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Professional Information

I am licensed in the State of:

As a:

I am also licensed in:

As a:

Professional Organizations

Family Courts

Education

Instutution

Years Attended

Major

Degree

Year Awarded

Institution

Years Attended

Major

Degree

Year Awarded

Additional Education

References

Following are the names and telephone numbers for two colleagues who can verify the accuracy of this Application:

Name

Phone

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Name

Phone

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Terms & Conditions

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 understand that the state(s) where I plan to offer my professional services as Custody Evaluator and/or Parenting Coordinator are legally able to regulate any and all court related activities within their state boundaries. I understand that they may now or in the future, require any or all of the following: licensing fees, license charges, charges for commercial activities within their jurisdiction, state administrative charges, state criminal background checks (to include fingerprinting), specific training for Custody Evaluators and/or Parenting Coordinators, additional educational requirements, state certifications, etc. By submitting, I agree to the above terms of use.