241562 01/27/15 �( �'! CITY OF CARMEL, INDIANA VENDOR: 360470
® ; ONE CIVIC SQUARE NATIONAL RECREATION & PARK ASSO@HECK AMOUNT: $*"*****65.00*
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CARMEL, INDIANA 46032 PO BOX 5007 CHECK NUMBER: 241562
M�troN`�°' MERRIFIELD VA 22116-5007 CHECK DATE: 01/27/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4341999 BAUMGARTNER 65.00 OTHER PROFESSIONAL FE
JAN- 11,2015..
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2014 CPRP Renewal Application
Return application and all documentation to:
National Recreation and Park Association
CL#500007
nrrti PO Box 5007 !'
Merrifield,VA 22116-5007 1°Avct: {
Please print or type
Title(e.g.Mr./Mrs.): 1l,.- First Name: MI: L Last Name: ba
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Mailing address: 1245 C_on&n eel PpkriL br F-a&I
City: Wtsk Aej d State: 1111 Zip: 460`lA
Home Phone: 311- (pT1-0Bk5 Work Phone:
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CERTIFICATION FEE INFORMATION
Renewal Apulication Fee . Exam Fee(If needed) TOTAL
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NRPA Member:$65.00 CPRP Exam$195.00 Application Fee (os.
Non-NAPA Member:$75.00 *Only if you have not obtained Exam Fee(*if needed*) +
Current Student:$50.00 required 2.0 CEUs* Total Due:
SAVE$5 by filling out your CPRP Renewal Application Online through the Online Certification
at www.nt-ea.org/cern
Please nuke cheeks payable to:National Recivation and Park Association(NRPA)
OCheck Credit Card: OVisa ')MastcrCard O:metwanEipress OrAscolcr
Credit Old Number: Expiration Date:
Name on Credit Card: Y__ _ _ Ctcdit Card Security Code:_
sipulurc:
Hil1'tne 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. Cerdficants 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 certi,ficant is selected for an
audit).
TRACK YOUR CEUs ONLINE-Visit the NRPA Online Certification Center(at www.n pa.orp/certification)to begin tracking
your CEUs for your next CPRP renewal date.
Program Program Program Title CEUs/College
Date(s) Location _ _ _ _ _ Credits_Acquired_
I25
031�,/�1 ► } CO
Pre�o��-:..e� bio. i4�o CPRS ek-WA
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5 -6 attvs ir., q SVCtP53F+1 12
pec. C2►^kr 5
Ge11r'IOve •115
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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 medi an ge ral public. '_ . f
Signature Date I'll
_ -2-
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-
;4
cquired-is lio poles w10 1K to d3 • 10
to NTA C�,Wk-A . .10
3110 Moriorn CWV4. CQKkr 5}eWa,wds orr Cln��dreh �1ro►;n�h 3Q
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. I authorize NRPA and the
National Certification BqArd4o release my contact information and current certification status to appropriate park and recreation
leadership,the me ' feral public.
Signature Date 12131114
-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
1/12/15 K.Baumgartner CPRP Renewal xx1600 $ 65.00
i
Total Is 65.00
I 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
1
I
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1091 K.Baumgartne 4341999 $ 65.00 1 hereby certify that the attached invoice(s), or
bill(s)is(are)true and correct and that the
I materials or services itemized thereon for
i
which charge is made were ordered and
ireceived except
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I
i
January 22, 2015
l
I, Signature
$ 65.00 Accounts Payable Coordinator
Cost distribution ledger classification if ` Title
claim paid motor vehicle highway fund IIII
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