Supervisory Candidate Extension Request

Supervisory Candidate Extension Request

P.O. Box 9166, Fleming Island, Florida 32006 Executivedirector@cpei.us
CPEI is committed to assisting individuals who have been accepted in our Supervisory Education process to be diligent in completing the process. Therefore, the following timelines have been established by the Credentialing Committee:
- Supervisory Candidate I (Enrolled in SEC 600-900) to have this process completed within 18-24 months.
- Supervisory Candidate II (Conducting Solo Course of CPE) to have this process completed within 6 to 12 months.
I am enrolled as a:*

Supervisory Candidate ISupervisor Candidate II
Name*

First NameLast Name
CPEI Membership #*
E-mail*
example@example.com
CPEI Affiliate Organization*
Name of Training Supervisor*
Date Started Supervisor Education with CPEI*
Supervisory Candidate I Status of Completion (Check all Applicable Boxes)
Supervisory Candidate II Status of Completion (Check all Applicable Boxes)
Explanation for Request (Include Proposed Plan with Date to Complete)*
Should be Empty: