We encourage you to complete the registration on-line. However, if you must mail in your application, please note you will be required to pay by company check, money order or certified check. No credit card information will be accepted via mail services. Also note that the processing of your application will be delayed if you choose to submit your information by mail.
To apply for certification now, please click the link for your exam at the bottom of this page. You will have the option of paying by credit card at the end of the application process. You will also have the option of mailing your payment. Once again, your final eligibility status for taking the test will be delayed if you choose this option.
Note: No part of your application will be processed until payment is made. If you cancel the application process anytime before payment is made, no information will be saved but you can re-apply at anytime.
The estimated application time is 10 to 15 minutes. We recommend that you thoroughly review the eligibility requirements and gather the information you need before you begin in order to expedite the application process.
You will need
Information on your dementia care experience
Name and Address of Employer(s)
Contact Name and Phone Number for Verification
Month and Year of Service
Information on your dementia care training
Month and Year of Training
Name of Course or Training
Number of Training Hours
Location of Training
Name of facility, school or training site + contact name and phone number for verification OR
If training completed online, you will need website address
Please note that you may list up to fifteen (15) courses for your dementia care training. If you need more entries to meet your eligibility requirements, you cannot apply online. Please print your application below and mail with payment to the address given.