CCO Administrative Appeals Form

CCO is committed to a policy of courteous, fair, and efficient interactions with all program participants.

Nevertheless, from time to time, individuals may receive an adverse administrative decision from CCO. CCO recognizes the importance of treating all program participants equally and fairly, and providing each individual with appropriate due process.

Accordingly, in written notices with adverse administrative decisions, individuals will be notified of their right to lodge an administrative appeal in written notices with adverse administrative decisions. In cases where a program participant wishes to appeal an adverse administration decision from CCO, individuals may submit an administrative appeal with this form.

However, not all requests are grounds for administrative appeals. Administrative appeals may include, without limitation, requests for a recertification deadline extension or revalidation of an invalidated examination, appeals from denial of a request for testing accommodations, or appeals from adverse administrative decisions. 

PLEASE REVIEW THE ADMINISTRATIVE APPEALS POLICIES & PROCEDURES BEFORE BEGINNING THIS FORM.

Contact adminappeals@ccocert.org with any questions.

Appellants may provide additional documentation in support of their administrative appeal, such as medical documentation.

Documentation is not required for an appeal to be considered, but is recommended depending on the type of appeal. 

Documentation submitted shall be limited to ten (10) pages.

I declare that the information contained in this administrative appeal form, as well as the information in any required accompanying documentation, is true and accurate. I understand and agree that my failure to provide accurate and complete information may constitute grounds for rejection of my appeal. I expressly consent to CCO’s release of any information consistent with the CCO Information Release Policy, and I expressly consent to the CCO Privacy Policy as set forth on the CCO website.

I attest that I am submitting this application on my own behalf.

I understand that submitting this form alone does not grant approval of my administrative appeal until a decision is communicated in writing by CCO.

By signing below and submitting this administrative appeal, I acknowledge that I have read and understood the Administrative Appeals Policies and Procedures, and that the decision of this appeal will be final.