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HomeMy WebLinkAbout307532 01/25/17 CITY OF CARMEL, INDIANA VENDOR: 360470 ONE CIVIC SQUARE NATIONAL RECREATION & PARK ASSOCHECK AMOUNT: $......**65.00* CARMEL, INDIANA 46032 22377 BELMONT RIDGE ROAD CHECK NUMBER: 307532 9ASHBURNVA 20148 CHECK DATE: 01/25/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4341999 1/4/16 65.00 OTHER PROFESSIONAL FE w o rn = a 0 o =r sc o z o m D Z o n n o d o m c0 rn o Z c O :<:::.: m 30- .. 3 a c D N w n0 -p 0 CD C ►:.::.;;: '. co D »»: :;;Gx;: o D O C. Z m o N °i cin z p 0 0 0 0 o s m s D m• m o = m _ - (n < m _ CD n NQ fD CL CD N 0 O D CD m CO � m n C- N• m 2 no 3 z m n _ = a N M� cn a� m CD o 3 O °' W < N NN O fD Q N n CD z a C) p . m C) v N N n o. K � Q. = CD O p� O O 3 p Q Q .�. m N I m N ( N O p µ r. JAN 1 6 2011 NR PA BY:....................... P Renewal National Re7.reatlon ano Prk AApplication scricl<alon Title(e.g. Mr./Mrs.): Mr First Name: �� ��� ( MI: :. Last Name: rM A n d+ Address(Work/Home): I a 3 CC K I ( PaY r- , &f f City: ��~MLI State: N Zip: y�Q Home Phone: Work Phone: 31 -7 g L1.3 - 3'9 Email address: 614#6 1thA 0 Cltrne l C.ky fork f, (o M NRPA member?tyess-Membership#ag�� �l0 t No CERTIFICATION FEE INFORMATION Renewal Application Fee Exam Fee (If needed) TOTAL NRPA Member:$65.00✓ PRP Exam$195.00 Application Fee / e Non-NRPA 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.nri)a.org/cprp Please make checks payable to:National Recreation and Park Association(NRPA) echeck Credit Card: )Visa (MasterCard OAmencan Express ODiscover Credit Card Number: _._.......__._............ Expiration Date: Na mc on Credit Card: CV1": 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. ' w ' CONTINUED PROFESSIONAL DEVELOPMENT SUMMARY (Must be completed and submitted for application to be processed) All CELls claimed for renewal must have occurred within your current 2-year certification cycle. Certificants must have official documentation to support CELls claimed below that include the following information:certificant's name,program dates,times and the number of CELls 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 CELls for your next CPRP renewal date. Program Program Program Title CEUs/College Credits Date(s) Location Acquired q 114.?/11 .c ►Iyl1� lhd aha��i, 5 , TN T1APui (,nt, CAucA� on (ours I"i365'►Aoo 9 � lig- Lu5 ve 1,15 Al V A.Jen( A(cr{d011 pus Vejg5 A[\/ Ne,r�,, ioa (A,a ( Ay a - 1,5 / v (re1ifiYJ Los fin 64 Mer /\"7g(a+IVn53- 1115- IS Lus �e�as , NV RPcA i+ C?SS ,'vn s © - j i� 115- Vey v 1F Y,4 Aoy� rC7G1 S�Ir'ZY✓ SC/S �� ell 5 t/ e l 117 e , I �J��.� � � S(/CIgI MPd 0 , a 117 111, A( M e 1VI L M a PI 'l) I a1 /O u r a 1I-7 11� �( me , M L T�e us, ne5f e /2url(f and /pec U - I1� 11b � (me M L C3\A Id +LAre (;-5+. Sir✓. �xC . (3 . .� 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 Board to release my contact information and current certification status to appropriate park and recreation leadership,the media,and the �lgeneral public. A Signature ' � � � Ar Date 1 I! Z -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 certificont 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 Credits Date(s) Location Program Title Acquired 6 4 A CMB ) M1 My H li 5 C 411,1 v6,Ltr HP 0 - 1 aIIgI (V A( me M Z /Ome f-� Y 4bo ',4 lUPN I C�IIt cred, t to CFI45 N n, PA Zoic C Gh"(, _ L,;S VP u_S U.s M,G� ;9r,h 4( d- ASf"C . ' 0016 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 Board to release my contact information and current certification status to appropriate park and recreation leadership,the media,and the/general public. ! Signature A/1 Yzuq Date V -2 -