Conversion to Emeritus
Please note that conversion to Emeritus is a permanent status; however, you are expected to continue to abide by the Rules of Professional Conduct. Failure to do so may result in revocation of Emeritus status. In order to convert to Emeritus, you must have been certified for 10 years and be in good standing with ABC.
Name
First Name
Last Name
Certificant Number
Email
example@example.com
Scope(s) of Certification
Certification Expiration Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Departure From Forensics
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Emeritus Conversion Approved by Registrar
Approved
Denied
Comments (if denied, please explain why)
Date of Emeritus
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: