NACM Brochures 2017 NACM Professional Certification Program - Page 15

Application for the Certified Credit Executive ® (CCE ® ) Designation Testing Location The exam will be given at your local affiliated association office unless special, advanced arrangements are made. If you wish to test at a location different from your affiliate office (must be approved by NACM), please provide proctor information below. Proctors must be in a supervisory role or a human resource representative from your company. Proctor Name Proctor Title Shipping Address (street address only) Email Phone I hereby apply for admission to the Certified Credit Executive (CCE®) Designation one of the plans defined below: (Choose One) q Plan A: 125 documented roadmap points, 10 years of experience and having earned a four-year college degree q Plan B: 125 documented roadmap points and having earned the CBA SM and CBF SM q Plan C: 125 documented roadmap points, 15 years of experience and 57 years of age or older q GSCFM: Upon successful completion of the second year of the Graduate School of Credit and Financial Management® q CCP Holder: Holder of the Certified Credit Professional (CCP) Certification of Canada q C  heck here if upon receiving the CCE® designation, you would like NACM to notify your immediate supervisor (only one name please) of your achievement. The NACM president should send the notification to: Mr./Ms. Name of Supervisor Supervisor’s Title Company Mailing Address City State/Province Direct Phone Email Address Zip/Postal Code Country I understand that I must take and pass the CCE® exam before achieving this designation. I also understand that should I earn the CCE® designation that I will need to recertify every three years until age 60 or until age 55 and formally retired. I have met all of the requirements for this designation as outlined in the NACM Professional Certification brochure and have attached a completed copy of the NACM Career Roadmap. By my signature, I agree to uphold the NACM Canons of Business Credit Ethics with the knowledge that any false statement or misrepresentation that I make in the course of these proceedings may result in the revocation of this application, forfeiture of the application fee and prohibit me from participating in the Professional Certification Program. I further agree to conduct myself in all business dealings so as to reflect honor and merit upon the financial and business credit profession. Signature of Applicant Date I understand that by providing my mailing address, email and telephone number, i consent to receive communications sent by or on behalf of the National Association of Credit Management (NACM), FCIB-NACM, Inc., and its subsidiaries and Affiliated organizations, via regular mail, email, telephone. Signature of Applicant Date q Check here to opt out of the congratulatory listing published in Business Credit magazine. Return completed form to: NACM Education Dept., 8840 Columbia 100 Parkway, Columbia, MD 21045-2158 • Fax: 410-740-5574 • Email: 15