241338 01/22/15 o� C4_q
�yf CITY OF CARMEL, INDIANA VENDOR: 360470
® c' ONE CIVIC SQUARE NATIONAL RECREATION & PARK ASSOCHECK AMOUNT: S********65.00*
CARMEL, INDIANA 46032 PO BOX 5007 CHECK NUMBER: 241338
°Opp on�o,? MERRIFIELD VA 22116-5007 CHECK DATE: 01/22/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4341999 LEWALLEN 65.00 OTHER PROFESSIONAL FE
2014 CPRP Renewal Application
' :'. Return application and all documentation to:
National Recreation and Park Association
CL#500007
PO Box 5007
Merrifield, VA 22116-5007
Please print or type
Title(e.g. Mr./Mrs.): First Name: '�,hMI: Last Name: Mewl�Jy�
Mailing�address: 12?JS �,f K V OVI �(�✓�¢- lV�
City: ( (LI 'd. State: Zip:
Home Phone: 3 i I 21 Ss I I Work Phone: I
Email address: SIeWOVUe" C, Sg` wd ('jI,(kq 12wyS- NRPA member? Yes- Membership# ❑ No
CERTIFICATION FEE INFORMATION
Renewal Application Fee Exam Fee (If needed) TOTAL
NRPA Memb : $6
5.00 CPRP Exam$195.00 Application Fee �s,LSD
Non-NRPA Mem75.00 *Only if you have not obtained Exam Fee(*if needed*) +
Current Student: $50.00 required 2.0 CEUs* Total Due: _ (QS. OD
SAVE $5 by filling out your CPRP Renewal Application Online through the Online Certification
at www.nrpa.or2/cprp
Please make checks payable to:National Recreation and Park Association(NRPA)
OCheck Credit Card: OVisa OMasterCard OAmerican Express ODiscover
Credit Card Number: _ _ Expiration Date:
Name on Credit Card: _ Credit Card Security Code.
signature:
Billing Address: _
--- --..........-------
-—...__..._
CONTINUING EDUCATION UNIT (CEU) REQUIREMENTS
Continuation of certification shall be contingent upon completion of a minimum of two(2.0)Continuing Education Units or equivalent
academic course work from an accredited college or university in each 24-month period. Note change: Please do not send official
documentation of continuing education to NRPA unless you are requested to do so as part of the audit process. The second page of
this application must be completed and submitted as proof of your CEU requirement completion. Upon receipt of the recertification
application,NRPA will select a random percentage of applications for audit. Certificants who are selected for audit will be directly
notified by NRPA. Certificants will have 30 days to submit their continuing education materials for the audit process. Failure to
submit the continuing education materials in a timely manner will result in a denial for recertification. If you do not have your required
2.0 CEUs you must re-take the current CPRP exam within your certification cycle.
CONTINUED PROFESSIONAL DEVELOPMENT SUMMARY
(Must be completed and submitted for application to be processed)
All CEUs claimed for renewal must have occurred within your current 2-year certification cycle. Certificants must have official
documentation to support CEUs claimed below that include the following information: certificant's name, program dates,times and
the number of CEUs or college credits acquired (these forms do not need to be submitted unless the certificant is selected for an
audit).
TRACK YOUR CEUs ONLINE -Visit the NRPA Online Certification Center(at www.nrpa.org/certification)to begin tracking
your CEUs for your next CPRP renewal date.
Program Program CEUs/College
Date(s) Location Program Title Credits Acquired
2 3114
io/ILVI —
i LP-, N C
i
AGREEMENT TO ALL TERMS
AGREEMENT TO ALL TERMS—I certify that all the information given in this application is true and correct to the best of my
knowledge. I further understand that false representation relative to any information will provide the basis for withdrawal of
certification. I have read, understood and agree to comply with the CPRP/CPRE Policies and Procedures. 1 authorize NRPA and the
National Certification Board to release my contact information and current certification status to appropriate park and recreation
leadership,the
14WAmedia,and the general public. .
Signature l.QW�/ ,�JV` Date _(
I
-2 -
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
360470 NRPA Terms
P.O. Box 5007
Merrifield, VA 22116-5007
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
1/6/15 Lewallen CPRP Renewal xx1580 $ 65.00
Total $ 65.00
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20_
Clerk-Treasurer
Voucher No. Warrant No.
360470 NRPA Allowed 20
P.O. Box 5007
Merrifield, VA 22116-5007
In Sum of$
$ 65.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1091 Lewallen 4341999 $ 65.00 1 hereby certify that the attached invoice(s), or
bill(s)is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
January 15, 2015
Signature
$ 65.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund