TEP Initial Application | MIA-World.org

TEP CERTIFICATION APPLICATION

Initial

For the application of a NEW course level, MIA strongly recommends reviewing the guidelines of that course level. All documents (PDF) relating to MIA Certification Standards and Procedures are located here.

Please download the Practicum Site List and Faculty List files below. This should be uploaded on this page along with the submission of the TEP application. For efficient processing be sure all documents are filled in completely before uploading them.

Note: If yours is an established MACTE accredited program, you may submit the MACTE version of Faculty Summary and Practicum List in lieu of the MIA forms.

If you would prefer to download a PDF version of the application to complete and save on your computer or to fill in by hand, the TEP Application Form is available below.

Practicum Site List

Faculty Summary Form

TEP Certification Application Form

Date

MIA Membership Number

Legal Name of Organization

Training Program: Type name exactly as it should appear

Program Address

Shipping Address (if different from above)

Name of Owner/Director

Program Email Address

Program Website

Program Phone Number

Program Facebook Page

Date Program Established

This application is for a satellite site (list name of main site below)

Program Director's Name

Program Director's Business Phone

Program Director's Email Address

Program Director's Cellular Phone

TEP Representative for MIA Voting Purposes

Voting Representative Email Address

Course Level #1 Seeking Initial MIA Certification

Level Coordinator (if applicable)

Is this renewal course level accredited with MACTE?

Yes, this level is MACTE accredited (list issue & end date)

No, but we are in the process (list date of application)

No, not accredited

Training Schedule for this renewal course for the upcoming 12 months (separate training dates with semi-colon. Exp. April 6 - May 16 2020; August 2020)

Select the following changes that have been applied to yor prgram since last year. Supporting docments required.

Practicum Site (Download practicum sites list at the top of the page and upload below)

Faculty (Click the correct link below to fill out a separate substantive changes form)

Location (Click the correct link below to fill out a separate substantive changes form)

Legal Name (Click the correct link below to fill out a separate substantive changes form)

1. Click here for Faculty Changes

2. Click here for Relocation

3. Click here for TEP Name Change

Faculty List

Upload File

Upload supported file (Max 15MB)

Practicum Site List

Upload File

Upload supported file (Max 15MB)

Course Level #2 Seeking Initial MIA Certification

Level Coordinator (if applicable)

Is this renewal course level accredited with MACTE?

Yes, this level is MACTE accredited (list issue & end date)

No, but we are in the process (list date of application)

No, not accredited

Training Schedule for this renewal course for the upcoming 12 months (separate training dates with semi-colon. Exp. April 6 - May 16 2020; August 2020)

Select the following changes that have been applied to yor prgram since last year. Supporting docments required.

Practicum Site (Download practicum sites list at the top of the page and upload below)

Faculty (Click the correct link below to fill out a separate substantive changes form)

Location (Click the correct link below to fill out a separate substantive changes form)

Legal Name (Click the correct link below to fill out a separate substantive changes form)

1. Click here for Faculty Changes

2. Click here for Relocation

3. Click here for TEP Name Change

Faculty List

Upload File

Upload supported file (Max 15MB)

Practicum Site List

Upload File

Upload supported file (Max 15MB)

Course Level #3 Seeking Initial MIA Certification

Level Coordinator (if applicable)

Is this renewal course level accredited with MACTE?

Yes, this level is MACTE accredited (list issue & end date)

No, but we are in the process (list date of application)

No, not accredited

Training Schedule for this renewal course for the upcoming 12 months (separate training dates with semi-colon. Exp. April 6 - May 16 2020; August 2020)

Select the following changes that have been applied to yor prgram since last year. Supporting docments required.

Practicum Site (Download practicum sites list at the top of the page and upload below)

Faculty (Click the correct link below to fill out a separate substantive changes form)

Location (Click the correct link below to fill out a separate substantive changes form)

Legal Name (Click the correct link below to fill out a separate substantive changes form)

1. Click here for Faculty Changes

2. Click here for Relocation

3. Click here for TEP Name Change

Faculty List

Upload File

Upload supported file (Max 15MB)

Practicum Site List

Upload File

Upload supported file (Max 15MB)

Optional: Word File of Application

Upload File

Upload supported file (Max 15MB)

I have read and agree to follow the MIA Code of EthicsView MIA Code of Ethics

I have read and agree to the TEP Application Terms and ConditionsView TEP Applications Terms and Conditions

Your Signature

Upon submission, you will be redirected to the fees page for payment of this application. Please choose the appropriate item and submit your payment.