Introduction/Overview

Please complete this PRE-SERVICE Application for your dementia pre-service training to be reviewed for approval by LeadingAge Oregon. 

OAR 411-054-0070 requires that direct care staff receive pre-service training on the following topics:
  • Education on the dementia disease process, including the progression of the disease, memory loss, psychiatric and behavioral symptoms;
  • Techniques for understanding and managing symptoms, including but not limited to reducing the use of anti-psychotic medications for non-standard use;
  • Strategies for addressing the social needs of persons with dementia and providing meaningful activities, and
  • Information on addressing specific aspects of dementia care and ensuring the safety of residents with dementia, including, but not limited to how to: address pain, provide food and fluids; and prevent wandering and elopement.

You may start the application and come back to it anytime to finish it. 

If you have any questions as you complete the application, please send them to Merry Killam at  mkillam@leadingageoregon.org

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* 1. Name of Applicant/Company/Organization

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* 2. Type of Training Entity

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* 3. Application Submission Date

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* 4. Address (Address, City, State, Zip)

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* 5. Name of Person Submitting Application for Approval

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* 6. Email Address of Primary Contact Person for the Application

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* 7. Phone of Primary Contact for the Application

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* 8. Are you using one or more of the following "pre-approved" dementia training content sources to meet ALL of the pre-service training requirements?

* Oregon Care Partners
* Relias Learning
* IPCed / Easy CEU / OnCourse
* CARES Health Care Interactive
* M.O.V.E. Person Centered Training
* Teepa Snow PAC training

View the full pre-approved list on the DHS Website

If you answered "YES" to Question 8, your training is Pre-Approved and do not need to continue to complete this application.  Individual providers are responsible for keeping documentation to present to state regulators.  For example, if you are using a pre-approved training (e.g., Teepa Snow), you will need to indicate what topic the "pre-approved training" is addressing as outlined in OAR 411-054-0070.

If you need to print the list of pre-approved training for documentation for your records, visit DHS's Dementia Training Webpage.
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If you answered "NO" to Question 8, please proceed with completing this application.

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* 9. Select all pre-service topics you are seeking approval for:

Please answer the following questions relating the FIRST topic you selected in question 9.

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* 10. Please submit a PDF of your training material for this topic, not to exceed 25 pages.  If additional information is required for review, it will be requested later.

DOCX, DOC, JPEG, GIF, JPG, PNG file types only.
Choose File
No file chosen

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* 11. Indicate training format.  (If the training includes more than one format, choose the category that represent the largest portion of training time.)

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* 12. Indicate training content sources (e.g., name of book, author, name of video, copyright date, year training developed).

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* 13. Indicate instructional methods/adult learning principles used.  Check all that are used.  Straight text or powerpoint slides without information on the instruction methods/adult learning principles will not receive a full review.

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* 14. Enter the estimated length of time it takes trainees to complete the training.

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* 15. Indicate whether passing a written exam is required for completing the training.

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* 16. Are you seeking approval for more than one topic listed in question 9?

If you answered yes, please answer the following questions for the SECOND topic for which you are requesting approval.

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* 17. Please submit a PDF of your training material for this topic, not to exceed 25 pages. If additional information is required for review, it will be requested later.

PDF file types only.
Choose File
No file chosen

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* 18. Indicate training format.  (If the training includes more than one format, choose the category that represent the largest portion of training time.)

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* 19. Indicate training content sources (e.g., name of book, author, name of video, copyright date, year training developed).

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* 20. Indicate instructional methods/adult learning principles used.  Check all that are used.  Straight text or powerpoint slides without information on the instruction methods/adult learning principles will not receive a full review.

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* 21. Enter the estimated length of time it takes trainees to complete the training.

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* 22. Indicate whether passing a written exam is required for completing the training.

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* 23. Are you seeking approval for more than two topics listed in question 9?

If you answered yes, please answer the following questions for the THIRD topic for which you are requesting approval.

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* 24. Please submit a PDF of your training material for this topic, not to exceed 25 pages.  If additional information is required for review, it will be requested later.

DOCX, DOC, JPEG, GIF, JPG, PNG file types only.
Choose File
No file chosen

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* 25. Indicate training format.  (If the training includes more than one format, choose the category that represent the largest portion of training time.)

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* 26. Indicate training content sources (e.g., name of book, author, name of video, copyright date, year training developed).

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* 27. Indicate instructional methods/adult learning principles used.  Check all that are used.  Straight text or powerpoint slides without information on the instruction methods/adult learning principles will not receive a full review.

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* 28. Enter the estimated length of time it takes trainees to complete the training.

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* 29. Indicate whether passing a written exam is required for completing the training.

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* 30. Are you seeking approval for more than three topics listed in question 9?

If you answered yes, please answer the following questions for the FOURTH topic for which you are requesting approval.

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* 31. Please submit a PDF of your training material for this topic, not to exceed 25 pages.  If additional information is required for review, it will be requested later.

DOCX, DOC, JPEG, GIF, JPG, PNG file types only.
Choose File
No file chosen

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* 32. Indicate training format.  (If the training includes more than one format, choose the category that represent the largest portion of training time.)

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* 33. Indicate training content sources (e.g., name of book, author, name of video, copyright date, year training developed).

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* 34. Indicate instructional methods/adult learning principles used.  Check all that are used.  Straight text or powerpoint slides without information on the instruction methods/adult learning principles will not receive a full review.

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* 35. Enter the estimated length of time it takes trainees to complete the training.

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* 36. Indicate whether passing a written exam is required for completing the training.

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