Continuing Education Application for Certified Code Officials and Technical Assistants Directions: 1. Make sure your profile is up to date on the Online Registration System (required for certification) at: 2. Complete parts 1 - 3 of application. 3. Attach required documentation. 4. Submit to Virginia Building Code Academy office via email, fax, or postal mail to above noted address upon completion of total required hours. Failure to submit a complete and accurate application or to establish a current online profile may result in delays or rejection of application. All statements and documentation are subject to further review, investigation, and verification. Please notify the Virginia Building Code Academy office of any changes in address, employment location, and/or work status as well as update your profile on the online system with the appropriate information. Part 1: Applicant Information (please type or Name: Driver’s License Number: Home Address: Current Employer: Government Non-Government Employer Address: Position/Title: Date of Appointment: Work Phone: Cell Phone: Fax: E-mail: Part 2: Continuing Education Record (Please refer to attached Credit Record) Part 3: Required Signature Applicant: I attest that all information provided by me on this application is true and accurate to the best of my knowledge. I understand that falsification of any part of this application may result in denial of active certification status. Applicant’s signature: Date: ______________________ For office use only Date Received: Date Reviewed: Staff Initials: Date Entered: Date Returned to Applicant: Year Next Due: Approved Credit Hours Approved: Denied Application and documentation incomplete Education program content does not meet requirement Education credit hours do not meet requirement Administrative Part 2: Continuing Education Hours Credit Record
Continuing Education Application for Certified Code Officials and Technical Assistants Directions: 1. Make sure your profile is up to date on the Online Registration System (required for certification) at: 2. Complete parts 1 - 3 of application. 3. Attach required documentation. 4. Submit to Virginia Building Code Academy office via email, fax, or postal mail to above noted address upon completion of total required hours. Failure to submit a complete and accurate application or to establish a current online profile may result in delays or rejection of application. All statements and documentation are subject to further review, investigation, and verification. Please notify the Virginia Building Code Academy office of any changes in address, employment location, and/or work status as well as update your profile on the online system with the appropriate information. Part 1: Applicant Information (please type or Name: Driver’s License Number: Home Address: Current Employer: Government Non-Government Employer Address: Position/Title: Date of Appointment: Work Phone: Cell Phone: Fax: E-mail: Part 2: Continuing Education Record (Please refer to attached Credit Record) Part 3: Required Signature Applicant: I attest that all information provided by me on this application is true and accurate to the best of my knowledge. I understand that falsification of any part of this application may result in denial of active certification status. Applicant’s signature: Date: ______________________ For office use only Date Received: Date Reviewed: Staff Initials: Date Entered: Date Returned to Applicant: Year Next Due: Approved Credit Hours Approved: Denied Application and documentation incomplete Education program content does not meet requirement Education credit hours do not meet requirement Administrative Part 2: Continuing Education Hours Credit Record
Continuing%20Education%20Application_1.6.2017.docx