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It specifies applicant identity fields, attesting certificant eligibility (active BCaBA/BCBA/BCBA-D/FL-CBA status and employment or contractual relationship with the organization), and attestations confirming age, high-school-level education, and criminal background and abuse registry checks conducted within defined timelines. The form must be fully completed, signed within 90 days of payment, and retained for at least 7 years for potential BACB audits.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/rbt-certification-application-attestation-form-effective-january-2-2025/306534/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/rbt-certification-application-attestation-form-effective-january-2-2025/306534.png","ImageObject",442,249,{"name":88,"@type":89},"Xiajie","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-28","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",13,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"Who can complete the RBT certification attestation form?","Question",{"text":109,"@type":110},"A qualified attestor must complete it. 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If human resources staff at the organization confirmed that the applicant cleared both checks, the attestor may complete the form under two conditions. First, the attesting certificant must be familiar with the organization’s policies, procedures, and processes when vetting applicants for RBT certification. Second, the attesting certificant must be able to provide documentation to support their attestation if audited by the BACB.  \nThe RBT applicant will submit this form to the BACB in their RBT Certification application. The form must be signed within 90-days of paying for the RBT certification application. All fields of this form must be completed. Incomplete forms will be denied.  \nA. RBT Applicant Information  \nApplicant Legal Name:   BACB ID \\# (obtain from the applicant; located in their BACB Account):    \nB. Attesting Certificant Information  \nThe Attesting Certificant must:  \n• hold an active BCaBA, BCBA (BCBA-D), or FL-CBA and  \n• be employed at the same organization as the applicant or have a contractual relationship with the organization that employs the applicant  \nAttesting Certificant Legal Name:   Certification Type: 􀂆 BCaBA 􀂆 BCBA 􀂆 BCBA-D 􀂆 FL-CBA  \nBACB Certification \\# or BACB ID (located in the Attesting Certificant’s BACB Account):    \nName of organization where all parties are employed or have a contractual relationship:   Relationship of attesting certificant to this organization: 􀂆 Employed 􀂆 Contracted*  \n*Contract with organization maybe requested in the event ofan audit.  \nC. Attestations  \nBy signing below, I (Attesting Certificant):  \n• Confirm that the applicant named above is at least 18 years of age; and  \n• Confirm that the applicant named above has completed at least a high-school level education or equivalent; and  \n• Confirm that the applicant passed a criminal background check comparable to those required of home health aides, child care professionals, and/or teachers in the community where services will be provided within 180 days of them submitting their application. The background check was conducted (complete ONE of the following fields):  \n􀂆 On   􀂆 Via continuous monitoring with the initial  \n(MM/DD/YYYY, date must be within 180 OR background check on    \ndays of the application being submitted) (MM/DD/YYYY)  \n• Confirm that the applicant cleared an abuse registry check comparable to those required of home health aids, child care professionals, and/or teachers in the community where services will be provided within 180 days of them submitting their application. If the applicant resides in a state or province without an abuse registry or the abuse registry information is unavailable to organizations like yours, then you may indicate “Unavailable.”  \nThe abuse registry check was conducted on    \n(MM/DD/YYYY, date must be within 180 days of the application being submitted)  \n• Acknowledge and agree that submitting falsified or inaccurate information to the BACB constitutes a violation of the BACB’s ethics requirements.  \nATTESTING CERTIFICANT PRINTED NAME:   \nATTESTING CERTIFICANT SIGNATURE:   DATE:    \n(MM/DD/YYYY)  \nThis document must be signed in accordance with the Acceptable Signatures Policy.  \nKeep a copy of this completed form and the supporting documentation for at least 7 years, as the BACB may request this information during an audit.  \nVersion 3/2025, Copyright © 2024, BACB® | All rights reserved. Behavior Analyst Certification Board | | 1","cbCaidp9f0tfsF5V","https://ap.wps.com/l/cbCaidp9f0tfsF5V","pdf",149823,"English","# Overview\n# A. RBT Applicant Information\n# B. Attesting Certificant Information\n# C. Attestations","[{\"question\":\"Who can complete the RBT certification attestation form?\",\"answer\":\"A qualified attestor must complete it. The attesting certificant must be familiar with the organization’s vetting policies and be able to provide documentation if audited by the BACB.\"},{\"question\":\"What requirements must the attesting certificant meet?\",\"answer\":\"The attesting certificant must hold an active BCaBA, BCBA (BCBA-D), or FL-CBA and be employed at the same organization as the applicant or have a contractual relationship with that organization.\"},{\"question\":\"What checks does the attestor need to confirm and within what timeframe?\",\"answer\":\"The attestor must confirm the applicant is at least 18, completed at least a high-school level education (or equivalent), passed a criminal background check comparable to specified roles, and cleared an abuse registry check. The background and abuse registry information must be within 180 days of the applicant submitting the application.\"}]","RBT Certification Application Attestation form - Effective January 2, 2025 | PDF",1789837702]