Recertification Exam Application

Recertification Exam Application

Process I for recertification
When: The Certification Exam is available April 1 - December 31

Where: The written exam is administered at a Scantron/Meazure Learning testing site (US & Canada Only).

Upon application approval, candidates will be contacted directly by Scantron/Meazure Learning to schedule the exam.

NOTE: Please read the "Exam Candidate Handbook" for full exam timeline and details.

A processing fee of $300.00 will be charged for all rejected applications.

Written Exam = $600 USD

The Exam is only available in English.

*Translators and/or dictionaries are not allowed*
Name*

First NameMiddle NameLast Name
Certification Number:*
Cert Year-ID # (YY-XXX)
Date of Birth*

MonthDayYear
Date
Personal E-mail (NEBO Comm. Only)*
example@example.com
Personal Phone Number (NEBO Comm. Only)*

Area CodePhone Number
Business Email
example@example.com
Business Phone Number*

Area CodePhone Number
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Color Copy/photo of Government issued ID*

Browse Files

Cancelof
Payment may be completed below on this form or a check may be mailed to NEBO, 2050 Keokuk St., NEBO Suite, Iowa City, IA 52240

Exam Payment

Written Exam $600.00

Written exam for recertification

Total $0.00

APPLICATION STATEMENT, SIGNATURE AND DATE