CSEP CERTIFIED PERSONAL TRAINER® APPLICATION

CSEP CERTIFIED PERSONAL TRAINER®
WORKSHOP/EXAM APPLICATION FORM
This form is intended for individuals seeking to qualify for the CSEP Certified Personal Trainer®
(CSEP-CPT) certification. For questions about obtaining your certification, contact the national
CSEP office at 1-877-651-3755. CSEP Certified Personal Trainer® is a registered trademark of the
Canadian Society for Exercise Physiology.
1. Contact Information
Name: ______________________________ Surname: _____________________________________
Address: _________________________________________________________________________
City: _______________________________ Province: ________ Postal Code: __________________
Phone:
Home: (_____) ______ - _________ Work: (_____) ______ - ________
Mobile: (_____) ______ - _________
E-mail: _____________________________________________________________
Preferred Language:
English
Français
I hereby acknowledge that the email address that I have provided to CSEP
may be used for communication purposes as long as I am a member of CSEP
(if no choice is selected, it is automatically deemed that you agree)
Agree
Disagree
2. Applying For Workshop/Exam...
(if known)
For a current list of scheduled workshops and exams, please visit www.csep.ca/csep-cpt
City: _________________________________________ Province: ___________________________
Course/Exam Date(s): ___________________________ Instructor: __________________________
3. Academic Requirements
College: ______________________________________ Graduation Year: _____________________
Diploma Program: ______________________________ Credential: __________________________
If not completed, years completed: ________________
University: ____________________________________ Graduation Year: _____________________
Degree Program: _______________________________ Credential: __________________________
2nd degree (if applicable): _______________________ Graduation Year: _____________________
Canadian Society for Exercise Physiology | Société canadienne de physiologie de l’exercice
#370 – 18 Louisa St. Ottawa Ontario K1R 6Y6 | www.csep.ca
CSEP CERTIFIED PERSONAL TRAINER® WORKSHOP/EXAM APPLICATION FORM - PAGE 2 OF 4
4. Specific Coursework Requirements
Candidates must provide formal documentation of having completed a minimum of 2 years of
college diploma or university degree coursework that specifically addresses the core competencies
of the CSEP Certified Personal Trainer®. These diploma or degree courses will be delivered in a
college or university program human kinetics, kinesiology, physical education, health sciences
and/or exercise sciences.
Use the table below to indicate which courses in your program apply to which core competency area(s).
The descriptions below are summaries of the detailed descriptions contained in the CSEP Certified
Personal Trainer® Candidate's Study Guide (available at store.csep.ca).
CORE COMPETENCY AREA
1.
Human Anatomy, Human Physiology, and Exercise
Physiology
May be integrated (in part) within courses dealing with the
understanding of the structure and function of the human
body including a basic understanding of the human body's
response to exercise.
2.
Theory and Methods of Behaviour Modification
May be integrated (in part) within courses dealing with
health behaviour change, physical activity behaviour
modification theories and models, interpersonal
communication, motivational interviewing, health
counselling, health and fitness promotion and the
determinants of physical activity and sedentary behaviour.
3.
Basic Theory and Methods of Health-Related Physical
Activity & Physical Fitness Assessment
May be integrated (in part) within courses dealing with:
fitness assessments, personal training, physical
activity/exercise prescription, training techniques, and
methods of training.
4.
Theory and Methods of Health-Related Exercise
Prescription and Program Design
May be integrated (in part) within courses dealing with:
personal fitness training, physical activity/exercise
prescription, training techniques, and methods of training.
Optimal program design includes appropriate
demonstration, client observation and exercise modification.
5.
Safety and Emergency Procedures
May be integrated (in part) within courses dealing with
emergency response procedures, injury assessment and
treatment.
6.
Documentation, Administration and Professionalism
May be integrated (in part) within courses dealing with
material related to marketing, administration, program
documentation and professionalism.
COURSE NUMBERS
e.g. PHYS101
COURSE TITLES
Introduction to Physiology
Canadian Society for Exercise Physiology | Société canadienne de physiologie de l’exercice
#370 – 18 Louisa St. Ottawa Ontario K1R 6Y6 | www.csep.ca
CSEP CERTIFIED PERSONAL TRAINER® WORKSHOP/EXAM APPLICATION FORM - PAGE 3 OF 4
5. Other Pre-Requisites
Please submit documentation of each the following along with your application:
Course Transcripts:
o An original copy of my College or University transcript, issued by my college or university, is
attached.
Other Pre-Requisites at time of membership registration
First Aid - is required at the time of membership registration.
CPR - is required at the time of membership registration.
Note: You will be required to submit documentation of current CPR level C (or equivalent) certification and
Standard First-Aid or Emergency First-Aid certification when you submit your membership registration form
following successful completion of the CSEP-CPT theory and practical exams. A CPR certification or recertification course must have been completed within the 12 months prior to the date you register for
membership with CSEP in order to be considered current.
Note: CSEP will ONLY accept certificates for CPR courses or CPR re-certifications that are delivered entirely in
person and include a practical component. On-line CPR courses will not be accepted.
CSEP will ONLY accept CPR certificates issued by:
(a) An organization that adheres to the ILCOR standards, OR
(b) An organization whose instructors are certified by and/or registered with an organization which
adheres to the ILCOR standards, OR
(c) An organization which adheres to the ILCOR standards for CPR courses/recertification delivered by an
independent instructor who is certified by and/or registered with that organization.
6. Fee
Application Fee*
o CSEP-CPT
$35
Tax (GST/HST)
o ON, NB, NL – 13%
o PEI – 14%
o NS – 15%
o AB, BC, MB, NT, NU, QC, SK, YT – 5%
_________
GST Reg. Nº R121749667
*Note: Application fee is non-refundable
Total:
_________
Canadian Society for Exercise Physiology | Société canadienne de physiologie de l’exercice
#370 – 18 Louisa St. Ottawa Ontario K1R 6Y6 | www.csep.ca
CSEP CERTIFIED PERSONAL TRAINER® WORKSHOP/EXAM APPLICATION FORM - PAGE 4 OF 4
7. Payment
Cheque or Money Order payable to the Canadian Society for Exercise Physiology enclosed
VISA
MASTERCARD
AMERICAN EXPRESS
Cardholder name: _____________________________________
Card number: ________________________________________
Expiry date (mm/yy): _____ / _____
CVD# ________
Authorized Signature: _________________________________
8. Send your completed form with required attachments and payment to:
By post:
CSEP/SCPE
370 - 18 Louisa St
Ottawa, ON K1R 6Y6
By fax: 613-234-3565
By e-mail: [email protected]
v2014-02-03
For CSEP National Office Use Only:
Date:
o
PERMISSION TO PARTICIPATE IN A CSEP-CPT WORKSHOP (40-44 HOURS)
o
PERMISSION TO CHALLENGE THE CSEP-CPT EXAMINATION
(theory and practical)
_________________
o
SUCCESSFUL COMPLETION OF THE CSEP-CPT THEORY EXAM
_________________
o
SUCCESSFUL COMPLETION OF THE CSEP-CPT PRACTICAL EXAM
_________________
o
CSEP-CPT INSTRUCTOR/EXAMINER: __________________________________________
_________________
o
PAID
_________________
CREDIT CARD
CHEQUE
MONEY ORDER
ONLINE
_________________
Canadian Society for Exercise Physiology | Société canadienne de physiologie de l’exercice
#370 – 18 Louisa St. Ottawa Ontario K1R 6Y6 | www.csep.ca