Online Application for Certification Form

 

 

Name(Required)
Address(Required)
Email(Required)
If you attended a different program then list it
Date of Completion:(Required)

Applicants must submit evidence of meeting a required pre-requisite for certification

AIHCP reserves the right to contact any providers of academic programs and verify completion/attendance by applicant
Drop files here or
Accepted file types: pdf, png, jpg, doc, docx, Max. file size: 100 MB, Max. files: 10.
    Candidates may have their University/ College send an official transcript directly to the AIHCP. Photocopies of University/College transcripts are acceptable, however AIHCP reserves the right at any time to request official transcripts for evaluating certification eligibility. Have transcripts mailed to: The American Institute of Health Care Professionals, 2400 Niles-Cortland Rd. S.E. , Suite # 4 Warren, Ohio 44484

    Higher Education:

    Undergraduate Education:

    Date Degree was Conferred
    Copy of Transcripts Included:
    Copy of Transcripts Previously Submitted:

    Graduate Education:

    Date Degree was Conferred:
    Copy of Transcripts Included
    Copy of Transcripts Previously Submitted:

    Licensure

    Applicants must submit a photo copy of their license or information on how their license can be verified

    Employment

    Work Address

    Your Supervisor or Human Resource Department Contact Information

    Address
    While we do not routinely contact employers, we do reserve the right to contact employers at any time to make a verification that the information provided on this recertification application is factual and correct, as provided by the applicant. By submitting this recertification application, you are providing your permission for AIHCP, Inc. to contact your employer for any possible verifications of employment status and job description information.

    Terms:(Required)
    By Typing your name below in the field box, you agree that this is the use of your digital signature.