Cycle Extension Form

In order to maintain your certification, you may submit a Certification Cycle Extension Request form. To be eligible for approval, you must meet the following requirements: Certification cycle must end on December 31, 2023, you must be a certified member, your membership dues must be up to date, and an extension request cannot have been approved previously.

Name*
First Last
Member ID*

Email*

Requirements
Have you previously received a certification cycle extension?*

Yes

No
Does your certification cycle end on December 31, 2023?*

Yes

No
Why were you unable to complete your CEU requirements during your regular four year cycle?*
How has/will your situation changed to allow you to complete your required CEUs within the next year?*
How many CEUs do you need to complete within the next year?*
Please detail your plan for completing the required CEUs. (Where, when, and how?)*
By signing below I affirm that the information I am providing is true and accurate. I acknowledge that I am requesting a one-year extension that is granted only once in a member’s lifetime and cannot be renewed. I understand that I have up to one year to complete the CEU requirement and that this extension does not extend the end date of any future certification cycles. I understand that my new cycle will begin the day following the activity that fulfills the entire 8.0 CEU requirement, and the follow-on cycle will have an end date of December 31, 2027.*
We will not be able to process this form. In order to be eligible for an extension request, you cannot have previously received one.
We will not be able to process this form. In order to be eligible for an extension request, your certification cycle must have ended on December 31, 2023.

Cycle Extension Form.

Requirements

We will not be able to process this form. In order to be eligible for an extension request, you cannot have previously received one.

We will not be able to process this form. In order to be eligible for an extension request, your certification cycle must have ended on December 31, 2023.

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