This form should be completed on an annual basis (for each certification you hold) and returned to the Certification Department for review and evaluation of recertification credits. The recertification expiration date for each certificate is December 31 of the final year of the term.
In order for us to process your application more efficiently and avoid delays, please follow these steps:
Keep a copy of all documentation for your records.
A copy of this form will be sent to the email address you specify below.
If you prefer to report your credits by mail, please download the PDF or MWord version of this form. Please remember to include the appropriate documentation.
Please note: required items are in red
Recertification form must be completed prior to submission. Incomplete forms will be returned.