CAPE Recertification: Practitioner Track Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.APENS Examination - Step 1 of 8I am recertifying with *Option 1 (APENS Exam)Option 2 (Portfolio)APENS Recertification Fee (for Option 1 and Option 2) *APENS Examination Fee - $250.00If you intend to have this application paid for as part of an OSEP 84.325K scholarship (i.e., grant), please list the project director below. 84.325K Project DirectorNextName: *FirstMiddleLast to Name), in If your school records are under another name (i.e., Maiden Name), please enter it here:Current Mailing Address: *Current School District, Institution of Higher Education, or Organization with which you are affiliated *Email Address: *Secondary Email Address (non-school email address):Preferred Phone: *Alternate Phone:Date of Birth: *Gender: *MaleFemaleTransgenderNon-binary/non-conformingPrefer not to repondIn which of the following settings do (did) you carry out your primary professional activities? Check all that apply. *PreschoolElementary schoolMiddle schoolHigh schoolTransition servicesHospital or rehabilitation facilityCommunity collegeCollege or universityAgency or organizationWhat is your current employment status in adapted physical education? *Full-timePart-timeRetiredNot working in adapted physical educationHow many years of experience do you have teaching physical education? *< 2 years2-5 years6-10 years> 10 yearsIf you are currently teaching adapted physical education, please indicate your primary professional activity: *Primary service provider: (e.g., provide direct instruction to students)Secondary service provider (e.g., provide consulting services to other teachers)AdministrationOther (please specify below)If you checked "Other" in the previous question, please specify here.For how many years have you primarily been an adapted physical education teacher? *< 2 years2-5 years6-10 years> 10 yearsnot applicableWhat is your primary motivation for seeking CAPE certification? *Required by employerPreferred by employerProfessionalismState requirementsTo enhance employment opportunitiesOther (please specify below)If you checked "Other" in the previous question, please specify here.With which race do you identify the most? *American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite (not Hispanic origin)In order to improve our APENS dissemination efforts, we would like to know how you learned about the examination. Please check one of the following and indicate the name of the person, place, or event below: *ProfessorEmployerCo-workerFriendWebsiteConventionCollege/UniversityOther (please specify below)Please indicate the name of the person, place, or event you checked in the previous question.Are you requesting special accommodations due to a documented disability or other documented reasons? *YesNoIf yes, APENS policy is that applicants who have a documented disability or limitation which prevents them from taking the test under standard online conditions may request special testing arrangements. Examples of accommodations that may be provided include large print, a person to read and/or mark the answer sheet, extended time, and/or a separate testing room. Documentation from a physician or appropriate authority is required for testing accommodations. This documentation, along with the specific accommodation being requested, must be submitted with your application materials to the APENS office.Upload the specific testing accommodations requested along with support documentation Drag & Drop Files, Choose Files to Upload You can upload up to 2 files. PreviousNextCurrent Valid Teaching Certificate in Physical Education 1. In what state do you hold current certification to teach physical education? *--- Select Choice ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin Islands2. Including physical education, what content areas are you certified to teach? Please include a PDF of any or all current licenses, certificates, or endorsements you possess to teach physical education in your state. Please note that your teaching certificate must be valid. If codes are used to identify content areas, please upload a copy of your state codes. Upload copy of teaching license(s) or certificate(s) along with state codes if necessary * Drag & Drop Files, Choose Files to Upload You can upload up to 10 files. Professional Portfolio (Option 2 Only) If you are an APE practitioner recertifying through Option 2, please upload your professional portfolio as one document inclusive of all evidence of professional activity and achievements, letters of verification, and/or resume. Upload Professional Portfolio (Option 2) Drag & Drop Files, Choose Files to Upload You can upload up to 10 files. PreviousNextPlease check you have read and acknowledge the following statements: I have completed this application for certification purposes only and will not disclose any information regarding the content of the examination, test questions, or test materials. *YesI authorize the NCPEID to communicate any actual or alleged violation of its rules or standards by me, the status of my application, and the pendency and outcome of any matters involving me to its certificants, state and federal authorities, employers, educational programs, insurance companies, and others. *YesI authorize the NCPEID to request information relevant to this application and my eligibility, certification, recertification and review of certification. I authorize any entity to furnish this information to the APENS Committee. *YesI hereby release, discharge, and exonerate the NCPEID and any person furnishing documents, records, and other information relating to my eligibility, certification, recertification, or review of certification from any and all liability of any nature and kind arising out of the furnishing or inspection of all documents, records, or other information and any investigation and evaluation made by the NCPEID. *YesBy entering your name below, you acknowledge that you have: 1) read and understand the entirety of this CAPE application, 2) provided honest and accurate responses to application questions, and 3) agree to abide by the terms set forth in this application. 1. Have you ever been convicted of, pleaded guilty to, or pleaded nolo contendere to a felony or misdemeanor which is directly related to public health or education? This includes but is not limited to rape, sexual abuse of a student, actual or threatened use of a weapon of violence; or prohibited sale or distribution of controlled substance, or its possession with intent to distribute. *NoYes2. Have you ever been found guilty of gross or repeated negligence or malpractice in professional work, which includes releasing confidential information of individuals with whom the applicant has a professional relationship? *NoYes3. Have you provided material misrepresentation or fraud in any statement to the NCPEID or to the public, including but not limited to, statements made to assist the applicant, certificant, or another apply for, obtain, or retain certification? *NoYesBy entering your name below, you are declaring and affirming that the above stated facts are, to the best of your knowledge, true and correct. Full name of Applicant *Date *PreviousNextPlease check each box to indicate you have read and acknowledge the following statements: I hereby authorize the APENS Chair, APENS Committee, and/or the relevant NCPEID officers, directors, committee members, employees, and agents to review my application for the CAPE certification *YesDuring the online examination, I authorize the proctors to monitor my exam period activities using strategies within their discretion (e.g., web-camera observations, use of LockDown Browser, and other techniques). I acknowledge failure to comply with these requirements before or during the examination may result in closure of the exam. I acknowledge that I will not communicate with others in any way during the examination. *YesIn the case of in-person examinations, I authorize the proctors at my assigned test site to maintain a secure and proper test administration location within their discretion. I acknowledge that in this capacity the proctors may relocate me before or during the examination. I acknowledge that I will not communicate with other examinees in any way during the examination. *YesIf I do anything that is unauthorized or prohibited by the NCPEID in connection with any APENS examination, I understand that my examination performance may be voided, and such activity may be the subject of legal action. In a case where my examination performance is voided, I will not receive a refund of the application fee, nor will I be credited for any future examination. *YesI understand that the NCPEID reserves the right to refuse administration of the in-person APENS examination if I do not have the proper identification (photo ID), or if in-person exam administration has already begun. If exam administration is refused, I understand I will not receive a refund of the application fee, nor will I be credited for any future examination. *YesI understand that I may only seek admission to sit for the APENS examination for the purpose of seeking CAPE certification, and for no other purpose. I will not disclose any information regarding the content of the examination, test questions, or test materials. *YesI understand that the review of the adequacy of examination materials will be limited to computing any scoring correction. I waive all further claims of examination review and agree to indemnify and hold harmless the above designated parties for any action taken pursuant to the rules and standards of the NCPEID with regard to this application and/or the APENS examination. *YesBy entering your name below, you acknowledge that you have: 1) read and understand the entirety of this CAPE application, 2) provided honest and accurate responses to application questions, and 3) agree to abide by the terms set forth in this application. Full name of Applicant *Date *PreviousNextYou have completed the information section of the application. On the proceeding sections, you will be prompted to review a summary of your responses, as well as, paying for the $250.00 APENS examination fee. We ask that you print your summary review for your records. PreviousNextUpdating preview…PreviousNextStripe Credit Card *Submit
