Application for Examiner Certification

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1. Examiner/Applicant's Name (This will be displayed on the certificate.)

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2. Examiner/Applicant's Email

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3. Agency Name

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4. Location/State

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5. Examiner Date of Hire

Date you were hired into your current position.

Date

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6. Is this a recertification request? (You must have been certified within the last 3 years if you answer yes.)

Yes

No

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7. Certification Level Requested

Certified State Credit Union Examiner (CSCUE)

Certified State Credit Union Examination Supervisor (CSCUES)