Recertification Credit Report Form

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.

Select the type of certification on which you are reporting:
 
Certification Type CPP™ PCI™ PSP™
Term Length Three years Three years Three years
Total Points Required in Term 60 45 45

In order for us to process your application more efficiently and avoid delays, please follow these steps:

  • Mail to the ASIS International the appropriate documentation for each activity, unless it is officially ASIS-sponsored and the information is recorded in the database.
  • All documentation should be submitted in the same order as you have listed the activities on the form.
  • Please be as specific and detailed as possible. If it is not apparent from the title of a course or seminar that it is clearly security-related, please include an explanation.

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

Name  
ASIS Number   Certif. number if not an ASIS member.
Email Address 
Term Expiration Year 
Employer  

Recertification form must be completed prior to submission. Incomplete forms will be returned.


1. MEMBERSHIP

ORGANIZATION (non-profit professional security association)
name
years
address
credits
claimed

ORGANIZATION (non-profit business management-related association)
name
years
address
credits
claimed

2. EDUCATIONAL PROGRAMS AND COURSES
Documentation is required (e.g., copy of course or workshop certificate, copy of report card, official government orders and/or travel voucher or other acknowledgement of completion).

PROGRAM/COURSE 1
sponsor
title of seminar/course
location
date(s)
hours
credits
claimed

PROGRAM/COURSE 2
sponsor
title of seminar/course
location
date(s)
hours
credits
claimed

PROGRAM/COURSE 3
sponsor
title of seminar/course
location
date(s)
hours
credits
claimed

PROGRAM/COURSE 4
sponsor
title of seminar/course
location
date(s)
hours
credits
claimed
PROGRAM/COURSE 5
sponsor
title of seminar/course
location
date(s)
hours
credits
claimed

3. INSTRUCTION, SPEECHES, AND OTHER PROGRAM PARTICIPATION
Documentation must show the certificant's completion of the activity (e.g. letter/certificate of appreciation or other acknowledgement of service).

PROGRAM 1
type of participation
date(s)
sponsor of program
program title or description
location
length of presentation
credits
claimed

PROGRAM 2
type of participation
date(s)
sponsor of program
program title or description
location
length of presentation
credits
claimed

PROGRAM 3
type of participation
date(s)
sponsor of program
program title or description
location
length of presentation
credits
claimed

PROGRAM 4
type of participation
date(s)
sponsor of program
program title or description
location
length of presentation
credits
claimed

4. PUBLICATION
Documentation is required (e.g., copy of article with publication date acceptance, letter from publisher, etc.).

CONTRIBUTION 1
title of contribution
publication name
pub. date
credits
claimed

CONTRIBUTION 2
title of contribution
publication name
pub. date
credits
claimed

CONTRIBUTION 3
title of contribution
publication name
pub. date
credits
claimed

CONTRIBUTION 4
title of contribution
publication name
pub. date
credits
claimed

5. VOLUNTEER SERVICE IN A CHARTERED SECURITY ORGANIZATION OR ASSOCIATION
Documentation is required (e.g., letter, certificate, roster, minutes).

POSITION 1
name of organization
position held
date of service
credits
claimed

POSITION 2
name of organization
position held
date of service
credits
claimed

POSITION 3
name of organization
position held
date of service
credits
claimed

POSITION 4
name of organization
position held
date of service
credits
claimed

6. PUBLIC SERVICE
(must be security-related, supporting documentation is mandatory):

PUBLIC SERVICE 1
description
credits
claimed

PUBLIC SERVICE 2
description
credits
claimed

PUBLIC SERVICE 3
description
credits
claimed

PUBLIC SERVICE 4
description
credits
claimed

PUBLIC SERVICE 5
description
credits
claimed

PUBLIC SERVICE 6
description
credits
claimed

7. OTHER ACCOMPLISHMENTS
(must be security-related, supporting documentation is mandatory):

OTHER 1
description
credits
claimed

OTHER 2
description
credits
claimed

OTHER 3
description
credits
claimed

OTHER 4
description
credits
claimed

OTHER 5
description
credits
claimed


Have you been convicted of a criminal offense in the past 3 years? (required)
No Yes
If yes, please explain: (required if Yes)



I certify that all statements, answers and representations made in this report
are accurate to the best of my knowledge. (required)