2020 Recertification Professional Development Report Submission

2020 Recertification Professional Development Report Submission

Use this form if you wish to claim points earned in 2020
Please complete this form in its entirity. To ease the review process, please ensure the filename(s) of your documents is named as follows:

Document type_Last Name_First Name_ Certificant Number

(For example: Reporting Form_Smith_John_1234)

If you are paying via PayPal, you will be redirected to a payment page.

NOTE: You must still submit your signed Rules of Professional Conduct (09-0001F) and your payment by March 1 so you do not incur late fees.
First Name
Last Name
Certificant Number *
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Upload forms and supporting documentation *

Browse Files
A .pdf is preferred (.doc, .docx and .jpg also accepted). Cancel of
How will your maintenance fees be paid? *

Personal Check PayPal Organizational check or PO
Should be Empty: