IBC Recertification Application

IBC Recertification Application

Application and fees are due to IBC on or before your date of expiration or the late fee will be due. Please note this page does not save, so if you navigate away from it your work will be lost. At the end of the application you will have the opportunity to print the file prior to submitting it. We do not accept recertification application by mail or email.
Credential You Are Recertifying:
Name (as you want on your certificate)
Other last names you have used:
Certificate Number:
Certificate Expiration

MonthDayYear
Date
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Personal Email
example@example.com
Personal Phone

Area CodePhone Number
Current Employer
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Email:
example@example.com
Employer Phone

Area CodePhone Number
Have you ever had any credential (i.e. license, certification, endorsement, etc.) revoked, suspended or sanctioned?
If yes, please explain what credential, when, where, why, and current status of the credential below. If no, please skip to the next section.
Professional Development Documentation

You do NOT need to submit copies of your certificate of completions listed below, however, be sure to keep copies of your certificates in case your recertification is audited by IBC. Application and fees are due to IBC on or before your date of expiration or the late fee will be due. Reminder: professional development classes are required to have taken place during certification period--anything prior to the certification date will not be approved.

CEU Training List

Rows	Training Date	Title of Training	Ethics #	Relevant Ed #	IBC Approved Mark Y/N
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training
Training

Total number of professional development hours submitted, as recorded below. A minimum of 40 hours required. IBC will reach out if we do not agree with the totals.

Rows	No. of Trainings	No. of Clock Hours
Ethics (3 hrs. required) IBC Approved
Ethics (3 hrs. required) Non-IBC Approved
Non-IBC Approved Relevant Education
IBC Approved Relevant Education

Attach any necessary documents

Upload a File

Cancelof
Submitting Form

IBC cannot view and/or review the form until it has been submitted. If the form is submitted correctly you should get a thank you page that alerts you that the form has been successfully submitted.
How will you be paying:
All pricing below includes the processing fee charged by our online payment vendor. These fees cannot be adjusted, and we are unable to accept payments over the phone.

Payments may be made online or by mailing a check. If you are paying by check you do not fill out the below options for payment, if you do it will require a credit card for submission--so leave it blank and move to the next section to sign the recertification application.

Recertification Payment Information:

Recertification$227.70

Recertification for 2 years

CEU Training Fee$15.53

CEU Approval Fee $15/ea. non-IBC approved cont. ed training

Quantity

Late Fee$51.75

(1-45 days late)

Printed Certificate$10.35

Printed Certificate mailed to you.

Quantity

Total $0.00

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Attest: I am attesting that all information above is correct and accurate.
*Please note: The print option is provided for your personal records only. Recertification applications must be submitted through the online portal to be processed. Applications mailed or emailed to the office will not be accepted. Please refer to the IBC Handbook for additional recertification policies and procedures.
Should be Empty:

IBC Recertification Application

Professional Development Documentation

Submitting Form

Recertification Payment Information: