There are two requirements to obtain a FM CORE Exception to IP Certification:
1. Points in each Question #4,5,6,7
2. A reference from a Master Instructor in Question #8

Applications are processed within 30 days.
Asterisk denotes required answer.

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* 1. Please enter date

Date

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* 2. Please enter your name

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* 3. Please identify your profession:

You must answer affirmative for each Question #4,5,6,7 in order to be certified for an Exception to FM CORE IP and proceed to the next question.

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* 4. Please confirm that:
(1 point)

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* 5. Please confirm the number of scans supervised by a FM CORE Master Instructor for each FM CORE module. 
(Parenthesis show # of required scans)
(8 points)

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* 6. Have you completed at least one CPoCUS/non-CPoCUS accredited FM CORE POCUS course as a participant? A minimum of one course is required.
(1 point)

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* 7. Have you taught at least one CPoCUS/non-CPoCUS accredited FM CORE course as an instructor or taught individuals? A minimum of one course is required.
(1 point)

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* 8. Please provide a short reference from a FM CORE Master Instructor. (1 point)

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* 9. Attach additional material (if applicable).

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 10. Attach additional material (if applicable).

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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