ACCBO 120 Day Extension Request

120 Day Extension Request Form

Fee - $50
Please note - 120 days is the MAXIMUM amount of time your certification can be extended during a re-certification period.

If you are currently on a 30 day extension, and request a 120 day extension, you will only have 90 days added to your extension - However, the 120 day extension is permanent (meaning when you re-certify, you will receive 2 years from your extended expiration date / this is not the case with the free 30 day extension).

Candidate Status cannot be extended through this form. If you are trying to extend your Candidate Status, please see https://mhacbo.org/en/forms-info/faq/
Please confirm that you have read the disclaimer written above *

Yes, I have read the disclaimer
Full Name *

First Name Last Name
E-mail *
Certification Number
Your certification number can be found on our online registry at www.accbo.com/registry
Home Phone Number *

Area Code Phone Number
Work Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Reason for requesting extension

My Products

120 Day Extension $ 50.00

Total $ 0.00

Payment Method

120 Day Extension Request Form