NAME AND ADDRESS CHANGE FORM.

National Council of Certified Dementia Practitioners®, LLC
55 Main Street, Suite 102
Sparta, NJ 07871
1973.729.6601 Toll Free
contact us form

Use the form below to submit a change in your name.

or

Certified members can update your contact info from your member account page. Click here to login to access your account.

 

TO ORDER A NEW CERTIFICATION CERTIFICATE...
To order a new certification and have sent to you by mail, please click here.

* - required fields
NCCDP maintains various registries for different certification. Please select where you would like for us to update your contact information.

Your certification account
Associate Membership
Corporate Membership
Postal mailing/billing List
Email mailing list

CADDCT Registry (please update your contact information yourself by clicking here.)
 

*Name:

Professionals Initials After Your Name EX. RN:

 

Old email address:

* Current Email address:
 

NAME CHANGE

Has your Name changed?



If your name has changed please provide documents (marriage license or government form) that denote the change. Fax to 973-860-2244 form with supporting documents

If yes, previous name:

FIRST NAME:
MIDDLE NAME:
LAST NAME:


New Name:

FIRST NAME:
MIDDLE NAME:
LAST NAME:

 

 

COMPANY NAME CHANGE

Company Name Currently Listed with NCCDP:

New Company Name to be listed with NCCDP:

HOME ADDRESS CHANGE

Old Address

  

Street Address:

City:

State:

Zip Code:

Country if other than USA:

 

New Address

Street Address:

City:

State:

Zip Code:

Country if other than USA:

 

PHONE NUMBER CHANGE

Old Phone Number:

New Phone Number:

   

LAST FOUR DIGITS OF YOUR STATE ISSUED ID CARD:
This it the number you provided in your initial application. This number is required as proof of identity.

   
 

COMMENTS:

 

Certified members can update your contact info from your member account page.. Click here to login to access your account.

 

 

Certified Dementia Practitioner ® CDP®, Certified Montessori Dementia Care Professional® CMDCP® and
Certified Montessori Dementia Care Professional Trainer™ CMDCPT™

The CDP®, CMDCP®, and CMDCPT™ are global certifications recommended for those working in the health care industry and with the geriatric population. These certifications are a compliment to your chosen profession. The CDP®, CMDCP® or CMDCPT™ are not a profession, but rather a level of additional Dementia training and Dementia certification that you have received in the area of Dementia care that will enable the health care professional to provide compassionate care.

The CDP® and CMDCP® certifications are a commitment by the professional to end elder abuse and neglect through continuous training in the area of Dementia Care. Worldwide there lacks standardization in the requirements of Dementia education for front line staff and health care professionals, elder care attorneys, educators, geriatric managers who work in learning institutions, psychiatric facilities, rehabilitation centers, associations, government agencies, nursing homes, assisted living, senior communities, adult day care, hospitals, home care and hospice agencies and 55 plus communities.