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Form VI Page 1 CONTINUING EDUCATION FOR PSP RECERTIFICATION Reply to NAEOP PSP Registrar Professional Standards Program National Association of Educational Office Professionals P. O. Box 12619 Wichita KS 67277-2619 Date Form must be verified by your local state or national PSP chairman or local/state president. If you hold one of these offices it is not permissible to verify your own forms. THIS FORM MUST BE TYPED and attached to Form V for recertification* Name of Applicant Address Mailing Address City State ZIP 4 Email Address Business School Name of business school Official transcript or statement/certificate of completion check one Enclosed Being sent from business school List courses/hours 1. College or University Credit Name of college or university List courses/credit hours Adult Education Inservice Education Continuing Education Courses Workshops or Seminars Attach copies of signed documentation within the five years prior to recertification date. Sponsoring Organization Title of Program Minutes or Hours I certify the above statements to be correct according to my knowledge. attached to this form* Signature of Applicant Signature of PSP Chairman local or state or President local or state Circle appropriate one. Subscribed and sworn to before me this day of Notary Public Name of Association My commission expires If you need additional writing space please continue on page 2 or use duplicate of this form* Total hours. O. Box 12619 Wichita KS 67277-2619 Date Form must be verified by your local state or national PSP chairman or local/state president. If you hold one of these offices it is not permissible to verify your own forms. THIS FORM MUST BE TYPED and attached to Form V for recertification* Name of Applicant Address Mailing Address City State ZIP 4 Email Address Business School Name of business school Official transcript or statement/certificate of completion check one Enclosed Being sent from business school List courses/hours 1. If you hold one of these offices it is not permissible to verify your own forms. THIS FORM MUST BE TYPED and attached to Form V for recertification* Name of Applicant Address Mailing Address City State ZIP 4 Email Address Business School Name of business school Official transcript or statement/certificate of completion check one Enclosed Being sent from business school List courses/hours 1. College or University Credit Name of college or university List courses/credit hours Adult Education Inservice Education Continuing Education Courses Workshops or Seminars Attach copies of signed documentation within the five years prior to recertification date. College or University Credit Name of college or university List courses/credit hours Adult Education Inservice Education Continuing Education Courses Workshops or Seminars Attach copies of signed documentation within the five years prior to recertification date. Sponsoring Organization Title of Program Minutes or Hours I certify the above statements to be correct according to my knowledge.

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