Please note that your continuing education and field hours should be calculated from January to December three years later.
Credential Program Status Maintenance Form

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* 1. Please write out your full name below.

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* 2. Please write out your CPA membership number.

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* 3. Your email address:

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* 4. Your phone number:

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* 5. Please write the year of completion of Certificate Level (date of Certificate Oral Practical Exam):

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* 6. Please write the year of completion of Diploma Level (date of Diploma Oral Practical Exam):

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* 7. Please write the year of your last Maintenance of Credential process (credentialed until):

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* 8. Please indicate your current Credential Level:

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* 9. First responder: Current Red Cross First Responder for Health Care Professionals Certification (or equivalent) valid until: (Please list MM/YYYY below)

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* 10. If expired, please let us know if you are registered for an upcoming course or on a waitlist :

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