Reactivation from Dormancy Request

Request to Reactivate after Dormancy
You cannot claim recertification points for activities earned while your certification is in dormancy. If you wish to claim points in the year that you return to work, you must choose to reactivate your certificate on January 1 of that year.
Name*

First NameLast Name
Certificant Number*
Preferred Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Email*
example@example.com
Date that your Dormancy began (January 1, _________)*

MonthDayYear
Date
Date of Return to Work*

MonthDayYear
Date
Requested Reactivation Date, if you wish to claim recertification points for this year, your dormancy will begin on January 1 of this year (January 1, __________)*

MonthDayYear
Date
Document your return to the forensic science profession:*
You may choose to upload documentation of your return to work.

Cancelof
Do you wish to receive a replacement certificate? Replacement certificates are $15 each.

YesNo
To purchase a replacement certificate, you may pay online on our Online Payments Page (Certificate Replacement Fee) or you may mail a check to:

Gretchen Lajoie

ABC Registrar

PO Box 418

Gardiner, ME 04345
Is the certificant in good standing?

YesNo
Registrar approval of the reactivation?

ApprovedDenied
Date

MonthDayYear
Date
Original certificate expiration date

MonthDayYear
Date
New certificate expiration date

MonthDayYear
Date
Was the original certificate returned?

YesNo
Was a new certificate issued?

YesNo
Comments
Should be Empty:

Request to Reactivate after Dormancy