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DVS Recertification Application Review
Month
/
Day
/
Year
Certification Type
Application
Has the Consent for Release of Information been signed?
Has the applicant signed the Professional Code of Ethics?
Has the application been signed?
Evaluation
Has at least one evaluation been submitted on behalf of the applicant?
Does the evaluation require follow up?
Training and Education
Has the applicant completed at least 24 hours of training and education since their last application was submitted?
Do the training activities cover at least three separate categories?
Recommendation
The Certification Review Pane may, at its discretion, require an interview and/or additional references. I recommend the following for the above named applicant: