Special Instructions for Online Applicants: Before you hit the submit button at the bottom of the page, you must print a copy of this completed application form to sign by hand and then mail.
Your application will be reviewed when we have received all of the required materials, including the nonrefundable processing fee, photograph, written material, transcripts (if required), previous CPE evaluations (if applicable), and letters of recommendation.
Please Note: Items marked with an asterisk (*) are required.
I certify that the information contained in this application and its attachments is true. I understand that falsification of information or incomplete statements will result in cancellation of this application. I agree that examination and verification of my employment and previous CPE education, except as it pertains to age, race, sex, color, creed, national origin, marital status or disability, may be made and used relative to my application status. I authorize my former CPE supervisors, employers, persons listed as references and other persons or organizations listed to provide this information and I release all concerned from any liability in connection therewith. I certify that as of the intended date of enrollment I will have graduated from an accredited high school or the equivalent and completed, in good standing, additional education and/or degrees as listed on this application and attachments. I understand that the application fee is not refundable.
Signature of Applicant (print first and then sign): ________________________________
Birth Date: ______________________ Social Security Number: ____________________
Today's Date: _______________________
