PSAP Certification Application

Pump Systems Assessment Professional (PSAP) Certification Application Form
Responsibility: It is the applicant’s responsibility to read, understand, and follow all instructions given in this application. It is also the applicant’s responsibility to submit a complete application and supporting documentation to avoid delays on processing. If you have any questions, contact the Hydraulic Institute at 1-973-267-9700 or certifications@pumps.org.

Eligibility: To be eligible for certification, applicants must have a minimum of five (5) years of professional pump system experience and an undergraduate or graduate degree in a STEM field or a total of seven (7) years of professional pump system experience.

General Information and Instructions:
1. Applicants must fully meet all eligibility requirements at the time of application prior to movingforward with the certification process. If you do not meet the eligibility requirements, your application will be denied.
2. This application must be filled out completely to be considered.
3. Please avoid using abbreviations that the application reviewer may not be familiar with. This will only delay the review. Spelling out abbreviations will aid in processing the application and avoid requests for clarifications.
4. A completed application form, supporting documentation, and fees must be submitted in order to proceed with processing your application.

Section 1: General Information
Close Date:

MonthDayYear
Date
Prefix:*

Mr.Mrs.Ms.Mx.Dr.
Name*

First NameLast Name
Email*
example@example.com
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please check here if you are requesting special accommodations for your examination.
What is your reason for applying for PSAP certification?*

Personal DevelopmentEmployer SuggestionEmployer RequirementOther
Section 2: Education
Type of STEM Degree:

NoneAssociatesBachelorsMastersDoctorate
Field of Study:
Year of Graduation:
School Attended:

School Name

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Section 3: Experience
How many years have you been working in the pumping industry?*
5 years minimum required for a PSAP Certification.
Provide a brief description of your pump system experience and typical job duties. Alternatively, applicants may also attach a resume below. *
Upload Resume

Optional
Cancelof

Certification Agreement
In order to qualify for certification, applicants must agree to each of the following statements. Read the statements carefully, then initial and sign at the bottom.
1. I agree to comply with and conduct myself in accordance with all HI certification program policies and requirements. In addition, I agree not to provide to any individual or organization in any manner, the specific content of examination questions or answers to such questions.
2. I agree to comply with and conduct myself in accordance with the the HI Certification Code of Ethics.
3. I agree to notify HI in a timely manner regarding changes concerning the information provided, including my current name, address, email address, and telephone number.
4. I agree that HI has the right to communicate with any person, government agency, or organization to review or confirm any of the information submitted in conjunction with my application for certification or renewal. Furthermore, I agree to and authorize the release of any information requested by HI for such review and confirmation.
5. I agree that all materials that I submit to HI become the property of HI and that HI is not required to return any of these materials to me.
6. I agree that upon achieving certification status, my name may be posted on the HI certification website as part of an online registry to be created and maintained by HI.
7. I agree that all disputes relating to my application or certification status will be resolved solely and exclusively in accordance with HI certification policies, procedures, and appeals processes.
8. I understand that HI reserves the right to suspend or revoke the certification of any individual who is determined to have failed to uphold or otherwise breached this agreement including any misrepresentations made in application or renewal statements.
9. I agree to discontinue use of my certificate and digital badge if for any reason I fail to maintain certification status or if my certificate is revoked.
10. I release and indemnify HI from all liability and claims that may arise related to my PSO and related activities.
11. I hereby release, discharge and indemnify HI, its directors, officers, members, staff, representatives/agents, and consultants from any actions, suits, obligations, damages, claims, or any other action taken in connection with this application and my examination.
In order to complete this application, you must attest to each of the following statements. Read the statements carefully, click the checkboxes, then sign and date at the bottom.*

I have read and accept the terms and responsibilities outlined in the Certification Agreement.The information provided in this application is true, accurate, and complete to the best of my knowledge. Additionally, I am willing to provide in a timely manner, any additional evidence requested by the Hydraulic Institute that supports the information provided on this application. I understand that falsifying information could result in the loss of my Certification.
Print Name:*
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Pump Systems Assessment Professional (PSAP) Certification Application Form

Section 1: General Information

Section 2: Education

Section 3: Experience

Certification Agreement