The NADD Accreditation and Certification Programs

To help insure that you have together all the information that you will need to complete this application, you may use the Summary of Experience and Education Worksheet (which is available for download on the website and can be found in the NADD Competency-Based Direct Support Professional Certification Manual). As a part of the application, you are required to indicate that you have read and will abide by the Code of Ethics. Upon completion and submission of the application, you will be taken to the NADD Store for payment of the application/exam fee.

Once your payment has been received and your application reviewed, you will receive instructions about taking the online exam.

Personal Information

Applicant Name

*

Street Address

*

City

*

State/Province

*

Zip Code

*

Email

*

Phone Number

*

How should your name appear on your certificate?

*

NADD Membership Requirement:

Organizations seeking accreditation and individuals seeking Clinical or DSP certification must have NADD membership before they can apply for accreditation or certification. Individuals who work for an organization that has a NADD organizational membership are considered members for this requirement. Be sure to have your individual or organizational NADD membership number when you are completing your application. If you do not know your membership number, you may call the NADD office (800-331-5362) for assistance. To join NADD now, click here.

Are you a NADD member? Yes No If so, what is your NADD membership number?

Does your employer hold a NADD organizational membership? Yes No If so, name of employer:

Employment History

List most recent employment first.

Work counted toward the required hours must involve Direct Support Work with individuals with intellectual/developmental disabilities or with a mental health diagnosis. The individual supported may carry both diagnoses. Direct Support Work is any work that is primarily with an individual. Work may be in any setting: employment, residential, family support, clinic, recreation, school, etc. Count hours of the experience where your main responsibilities are to support individual(s). It is recognized that not all hours are direct contact hours as there are many activities (meetings, planning, paperwork, etc.) that do not involve direct contact, however the primary purpose of these activities is to provide direct support. FYI, full time work (40 hours/week) for one year is equal to 2080 hours. You may estimate your total hours.

Work can be paid employment (full or part time), volunteer work directly with individuals, or student internships or learning experiences. The total number of hours worked must be at least 1,000. Although full-time work for a year greatly exceeds 1,000 hours, work must extend over 12 full months (do not need to be consecutive months).

Include contact information for the supervisor or person responsible for oversight who can verify your experience.

Employer #1		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Click here for another employer

Relevant DSP Volunteer Experience

Complete if you are using these hours to meet minimum DSP experience requirements.

Name of Volunteer Program or Agency Site #1		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Approximate number of hours spent working in direct support

Click here for another volunteer

Relevant DSP Internship Experience

Complete if you are using these hours to meet minimum DSP experience requirements.

Name of Internship Program Site #1		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
On-site Internship Supervisor’s Name
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Approximate number of hours spent working in direct support
Sponsoring Educational Program
Address
City
State/Province
Zip
Educational Program Supervisor

Click here for another internship

Summary of DSP Work Experience

(Paid, Volunteer, Internships)

Total months performing Direct Support Professional Work (listed above)

Total hours spent as a Direct Support Professional (listed above)

Educational History

List all education. College or other post-secondary training is not a requirement for this credential, unless required by your employer.

High School or GED Program

Attended From (mo/yr)

Address

Attended To (mo/yr)

City

State/Province

Zip Code

Course of Study (degree and major)

Degree Granted?

Yes No

College or Vocational Program #1 (not required)

Attended From (mo/yr)

Address

Attended To (mo/yr)

City

State/Province

Zip Code

Course of Study (degree and major)

Degree Granted?

Yes No

College or Vocational Program #2 (not required)

Attended From (mo/yr)

Address

Attended To (mo/yr)

City

State/Province

Zip Code

Course of Study (degree and major)

Degree Granted?

Yes No

Report of Continuing Education in Mental Health, Intellectual/Developmental Disability and/or Dual Diagnosis

Include courses, in-service training, on-line training, conferences, etc.

Report continuing education for this initial application. These continuing learning experiences may include relevant conferences, courses, in-service training, etc. List the date attended/completed, the title of training, the presenter along with their professional title, the length of the training to the nearest hour and the sponsoring/hosting agency for the training.

Date

Brief Title of Training

Presenter

Length of Training (hrs)

Sponsor

After you complete the application, click Submit below to submit your application to NADD. After submission you will be taken to the NADD store for payment.

I have read and accept the NADD Code of Ethics. (Click here to open in a new window).

Applicant Name	*
Street Address	*
City	*
State/Province	*
Zip Code	*
Email	*
Phone Number	*
How should your name appear on your certificate?	*

Employer #2		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #3		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #4		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #5		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #6		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #7		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #8		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #9		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #10		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #11		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #12		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #13		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #14		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Employer #15		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
Supervisor’s Name
Position		Direct Support Position?	Yes No
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Total number of hours worked

Name of Internship Program Site #2		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
On-site Internship Supervisor’s Name
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Approximate number of hours spent working in direct support
Sponsoring Educational Program
Address
City
State/Province
Zip
Educational Program Supervisor

Name of Internship Program Site #3		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
On-site Internship Supervisor’s Name
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Approximate number of hours spent working in direct support
Sponsoring Educational Program
Address
City
State/Province
Zip
Educational Program Supervisor

Name of Internship Program Site #4		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
On-site Internship Supervisor’s Name
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Approximate number of hours spent working in direct support
Sponsoring Educational Program
Address
City
State/Province
Zip
Educational Program Supervisor

Name of Internship Program Site #5		Date Started (mo/yr)
Address		Date Ended (mo/yr)
City
State/Province
Zip Code
Phone Number
On-site Internship Supervisor’s Name
Primary diagnosis of individual(s) supported	Intellectual or developmental disability Mental health diagnosis Other	Approximate number of hours spent working in direct support
Sponsoring Educational Program
Address
City
State/Province
Zip
Educational Program Supervisor

High School or GED Program	Attended From (mo/yr)
Address	Attended To (mo/yr)
City
State/Province
Zip Code
Course of Study (degree and major)	Degree Granted?	Yes No

The NADD Competency-Based Direct-Support Professional Certification Program Application