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Home My WebLink About214759 11/20/2012 �- CITY OF CARMEL, INDIANA VENDOR: 360470 Page 1 of 1 i'�• ONE CIVIC SQUARE NATIONAL RECREATION&PARK ASSOEHECK AMOUNT: $60.00 r CARMEL, INDIANA 46032 PO BOX 5007 �.o MERRIFIELDVA 22116-5007 CHECK NUMBER: 214759 CHECK DATE: 11/2012012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4358300 148264 60 . 00 OTHER FEES & LICENSES Carmel Clay Parks&Recreation CHECK REQUEST Date: 10123112 Check payable to: Name: IJo► iov\al ReCVeU ;ov` owd Pork Pass ia-ioh Address: t'0 Box 5 O City, State, Zip Merr iLaId 1 VAS 2211 to- 500? Mail check to payee Return check to requestor _ —co Check Amount: $ rWQ. Date Required: t 1 izol 1 Z _ Check needed for: CEP re-ceri Cakiov\ ��ea� ma►1 CAAC1'o cyan ~work wikh dc, To be paid from: PO#(if applicable) Budget account-GL# Budget Line Description Invoice(s)and Purchase Order(if required)MUST be attached. =BY:.Requested by(print): 0,v Requested by(signature): le- z I //— Y- Approved by(signat ure of Division Manager): � C, on this date 101�q' � - o Form revised 7-7-08 Shared/Forms/Business Services/Check Request Form/Check Request(rev 7-7-08) 2012 CPRP Renewal Application au . Return application and all documentation to: {>„•,;:;;; s;•c},;:.; } f” National Recreation and Park Association CL 4500007 PO BOX 5007 c.':}KI_.t::t:t Merrifield,VA 22116-5007 it Acc t: Please print or type / Title(e.g.Mr./Mrs.): J First Name: Kurl+s MI: L Last Name: gQU 4 y- Mailing address: l�oq 0 r i t2 Blvd- City: WetW&id State: I Zip: y07A Home Phone: 31-1- b01-O%G Work Phone: 31-1-/S-l�-5Z34� Email address: �Cbauytnoar�ner��nrrrQ�C\aynar�so_�irv� NRPA member? t9'Yes-Membership 4 ILAf�2bj ❑ No CERTIFICATION FEE INFORMATION Renewal Application Fee Exam Fee (If needed) TOTAL NRPA Member:$60.00 CPRP Exam$195.00 Application Fee ��D�•� Non-NRPA Member:$70.00 *Only ifyou.have not obtained Exam Fee(*if needed*) + Current Student:$45.00 required 2.0 CEUs* Total Due:_ S%D0•°2 SAVE $5 by filling out your CPRP Renewal Application Online through the Online Certification at w-Aw.nrpa.orjz/carp Please make checks payable to:National Recreation and Park Association(NRPA) hiCheck Credit Card: OVisa OMastetCard OAmericanExpress 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 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(atwww.nrpa.org/certification to begin tracking your CEUs for your next CPRP renewal date. Program Program Program Title CEUs/College Date(s) Location Credits Acquired � q� - I11111l 1 3 - - -- - 'hO��QhQ Wesleyan �h�rCU�1'V�� Glpb4� �SSU� s tkI914- t14112. IwU E�1�;�s ,Lawl �- Lecl�e�rs1.;P 3 j/10[%7-- 2-11,J11- t I W li 0 eamk ahs of Slvr-letS 3 3(2to 1�- tWU Ma�q�a,ria� EcovWw��s 312�Itz- 411312 �li�ly CSSeh�iwls a� FinatnGe. Cr¢�� 14 1114 JVL ►Jt ` [� 1025 12 �Vt/v �iCC� I �av�0►9Qri4\ �1nAY�CSC. l AGREEMENT TO ALL TERMS By signing,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 authorize NRPA and the National Certification Board to release my contact information and current certification status to appropriate park and recreation leadershi the media,and the general public. SIGNATURE: DATE: L0113'IL -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 10/25/12 148264 CPRP re-certification K.Baumgartner $ 60.00 Total $ 60.00 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 fyRPA— Il�l�t i �- � � Allowed 20 P.O. Box 5007 Merrifield, VA.22116=5007 In Sum of$ $ 60.00 ON ACCOUNT OF APPROPRIATION FOR 109 - Monon Center PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1091 148264 4358300 $ 60.00 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 15-Nov 2012 Signature $ 60.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund