Apply to be a BAA licensed institutional partner

Failure to upload all required documentation will result in a delay in processing your application. Please make sure to upload all documentation in each section that documentation is required before submitting

Name of Institution, School, or Program

Legal Name of Submitting Administrator

School Administrator Direct Phone Number

Education and Experience

How many professionals teach at your facility?

List First name and last name of all educational trainers/teachers at your school. Inly Listed trainers will be added to the school licensing and website registration.

What type of healthcare professionals can take your courses? (Select all that apply)

If you selected other, please elaborate, separate with a comma

What other regulatory bodies have accredited your courses or your school?

What experience does your institution have in educating or researching the modalities of the BAA Industry (Incisional Sciences & Technology, PostOp-Induration, Body Contouring, Client Advocacy, Pre & PeriOp Coordination, Plastic Surgery Compression Therapy, Plastic Surgery Wound Care, &/or Recovery Homeownership)

Background Check

These questions must be answered on behalf of the educators and trainers at your facility. It is the responsibility of the Educational Partnering Institution to ensure that the answers to these questions are accurate, true, and correct. In an effort to better serve the public trust, ACBAA reserves the right to conduct and/or review a criminal history background check and to deny an application and/or bar an Educational Partner status based on the commission of a crime. Such denials or barring shall be determined on a case-by-case basis.

Answers to the following questions are mandatory. Failure to respond to each question may result in the application being denied. Failure to provide accurate, true and correct information in answering these questions shall constitute grounds for denial of your application and/or barring rendered to your Advanced Scholastic Trainer Educational Partner status.

If all of the appropriate information is not provided, the processing of your application may be delayed, and your application will be considered incomplete. All information submitted in accordance with these questions shall remain confidential, except that it may be disclosed to CSL staff and legal counsel for processing and to law enforcement agencies, and any country, state, county and/or local governmental agencies as needed.

Has anyone at your school ever been convicted of, or entered a plea of guilty, nolo contender, or no contest to, a crime in any jurisdiction other than a minor traffic offense?

Yes No

Pending Criminal Case (Individual): Are there currently have a pending criminal case(s) against anyone at your school?

Yes No

Professional Conduct

Is there currently pending, or has there ever been, a complaint made against anyone at your school for professional conduct or competence in any; country, state, county or local jurisdiction?

Yes No

Has a barring sanction been imposed on anyone at your school, your practice, or your organization by a licensing or credentialing body? (A barring sanction is the imposition of a penalty based on the violation of procedures, policy, etc.)

Yes No

Professional Liability Insurance

Do you as an institution have professional liability insurance or does your organization provide its instructors with liability insurance?

Yes No

State/Jurisdiction Compliance

Are you and/or your organization in compliance with all of the rules and regulations within your state/jurisdiction?

Yes No

Administrative Processes

Are you and/or your organization in compliance with all of the rules and regulations within your state/jurisdiction?

As a provider of continuing education, I agree to comply with the ADA and Title VII of the CRA

Read the statements below and indicate with a check mark that you will comply per CSL guidelines. Registration, Cancellation, and Refund Terms of Service

I understand that it is required that my policies clearly state how participants register for my courses. I understand that it is required that my policies clearly state registration deadlines. I understand that it is required that my policies clearly state cancellation policies. I understand that it is required that my policies clearly state my refund policy

Agreement to Report Changes

l agree to report any changes in my answers

American Council of Body Altering Aesthetics Advanced Scholastic Trainer INSTITUTION Application

INSTITUTION INFORMATION

Education and Experience

Background Check

Professional Conduct

Sanction

Professional Liability Insurance

State/Jurisdiction Compliance

Administrative Processes

Agreement to Report Changes