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    Application Information







    Agency / Company Information:









    Preferred Postal Mailing Information

    - If same as above Please enter SAA for the address






     

    Certification Request





    Current Employer or School








    Proof of Required Course Work:



    (Limit: 1MB PDF or JPG file)




    Demographic Information:



    (Please specify highest level completed)



    This information will not be circulated outside the Certification Board. An affirmative answer does not necessarily mean rejection of your application. (Please omit offenses committed before your 18th birthday.)




    This information will not be circulated outside the Certification Board. An affirmative answer does not necessarily mean rejection of your application. (Please omit offenses committed before your 18th birthday.)


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    $50.00 of the certification fee is a non-refundable processing fee.

    (Upon successful completion of the form, please go to the on-line payment options.)