ICCDP Certified Montessori Dementia Care Professional Application and Renewal

ONLINE APPLICATION and CERTIFICATION PROCESS:

Complete 5 pages of the application form.
You may save your application and return at anytime to complete it.
Submit payment in the amount of $125.00 USD.
Your application will be reviewed by ICCDP. Upon approval your certification will be emailed to you.
For complete information about the certification process please go to the certification information page.

Following completion of this form you will be sent to a page to submit payment by credit card. We accept Visa, Master Card, American Express, and Discover.

Upon successful completion of your application, course work and test, you will be pleased to know that your name will be proudly displayed on our registry of Certified Montessori Dementia Care Professional . Only your name and credentials will be posted. Your contact information will not be posted.

I have completed ten hours of continuing education (do not proceed unless you have completed 10 hrs of continuing education)

Username (must be 8 characters long):

Confirm Password:

Personal Email Address:

Confirm Personal Email Address:

What is your current profession/position/title:

Type in your full name here:

First Name (Given Name):

Last Name (Surname):

Certifications and License credentials that appear after your name:
Example: RN, enter none if not applicable

Zip/Postal Code:

What country are you a citizen of?

Phone (please include your country code):

Date of Birth ( day/month/year example: 01/03/1982 ):

Have you ever been convicted of a felony/serious crime? Please check one.

If you have been convicted of crimes such as murder, rape, child molestation, slavery, theft, kidnapping you will be denied CMDCP certification.

If yes, please explain.

Name of Current Organization/Employer:

Type of Organization/Agency:
Select one

Government agency
Association
Nursing Home
Assisted Living
Psychiatric Facility
Hospital
Rehabilitation Center
Adult Day Care
Home Care Agency
Hospice Agency
Learning Institution
Management Company
Other:

Current Supervisor Name and title:

Current Supervisor Email Address:

Year graduated from High School:

College/University attended:

Year Graduated from University:

What experience do you have in working with patients with a diagnosis of Alzheimer’s disease or Dementia? (if none, enter NONE)

Alzheimer’s disease and Dementia Seminars
Please list seminars or courses or in-services or college classes you have attended: (if none, enter NONE)

Example: Title and Year, Communicating with an individual with Alzheimer’s Disease, 2014

Enter your Name:

ABOUT SSL CERTIFICATES

CMDCP Certified Montessori Dementia Care Professional is licensed by National Council of Certified Dementia Practitioners NCCDP for Use by ICCDP

The Grandfather Option permits you to submit an equivalent certification from a different certifying body so that you don't have to take our online course.

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