Acsi Certification Renewal Form – Fill Out and Use This PDF

Renewal Certiication Application

Contact Information

ACSI Certiication Registration Number (if applicable)__________________ Social Security Number (Last 4 digits) ______________

Mr.

Miss

Mrs.

Ms.

Mail Certiicate To:

School

Personal Address

________________________________________________________________________________________________________________________

Last Name	First Name	Middle Name	Maiden Name
________________________________________________________		________________________________________________________
Street Address or Post Oice Box		E-mail

________________________________________________________________________________________________________________________

City	State/Province Country	Zip Code/Mail Code	Home Phone/Cell Phone
________________________________________________________		________________________________________________________
Christian School Where Presently Employed (if applicable)		School Contact Person and Phone Number

________________________________________________________________________________________________________________________

Street Address or Post Oice Box

________________________________________________________________________________________________________________________

City	State/Province	Country	Zip Code/Mail Code
________________________________________________________		________________________________________________________
School Phone		School Fax

Statement of Faith

1.I believe the Bible to be the inspired, only infallible, authoritative, inerrant Word of God (2 Timothy 3:16, 2 Peter 1:21).

2.I believe there is one God, eternally existent in three persons—Father, Son, and Holy Spirit (Genesis 1:1, Matthew 28:19, John 10:30).

3.I believe in the deity of Christ (John 10:33), His virgin birth (Isaiah 7:14, Matthew 1:23, Luke 1:35), His sinless life (Hebrews 4:15, 7:26), His miracles (John 2:11), His vicarious and atoning death (1 Corinthians 15:3, Ephesians 1:7, Hebrews 2:9), His resurrection (John11:25, 1 Corinthians 15:4), His ascension to the right hand of the Father (Mark 16:19), and His personal return in power and glory (Acts 1:11, Revelation 19:11).

4.I believe in the absolute necessity of regeneration by the Holy Spirit for salvation because of the exceeding sinfulness of human nature and that men are justiied on the single ground of faith in the shed blood of Christ and that only by God’s grace and through faith alone are we saved (John 3:16–19, 5:24; Romans 3:23, 5:8–9; Ephesians 2:8–10; Titus 3:5).

5.I believe in the resurrection of both the saved and the lost: they that are saved unto the resurrection of life, and they that are lost unto the resurrection of damnation (John 5:28–29).

6.I believe in the spiritual unity of believers in our Lord Jesus Christ (Romans 8:9, 1 Corinthians 12:12–13, Galatians 3:26–28).

7.I believe in the present ministry of the Holy Spirit, by whose indwelling the Christian is enabled to live a godly life (Romans 8:13–14;1 Corinthians 3:16, 6:19–20; Ephesians 4:30, 5:18).

Airmation

I hereby airm by my signature that I subscribe to the ACSI Statement of Faith as it is written and attest that I have not been convicted of a felony, a crime of moral turpitude, or a crime involving child abuse, nor do I have a record of a founded charge of child abuse.

________________________________________________________	________________________________________________________
Signature of Applicant	Date

Renewal Certiication Application

Kindergarten–Grade 12 Certiication Process:

1.Fill out and submit the application.

2.Submit veriication of all renewal or upgrade requirements as listed on the Credit Evaluation* and Recommendation form.

3.Submit the application fee of $50 per level of certiication unless you are

a.Upgrading to Lifetime**

b.Upgrading a certiicate within 6 months of the evaluation date of current certiicate***

Instead of sending items piecemeal, please send only completed packets of renewal/upgrade materials.

*A Credit Evaluation and Recommendation form is attached to the bottom of each ACSI certiicate. This form lists the renewal and/or upgrade requirements, which must be completed before another ACSI certiicate can be issued. You do not need to submit the Credit Evaluation and Recommendation form.

**Lifetime certiicate: If you are renewing an ACSI Professional certiicate (not Temporary or Standard), please send a letter from an administrator or a school board chair stating that you have completed a minimum of 5 years as a teacher or an administrator in a Christian school setting. This letter, along with proof of the renewal requirements and the $60 U.S./$70 Canadian lifetime application fee, will ensure a Lifetime certiicate from ACSI.

***If you are upgrading your current certiicate within the irst six months of the issue date on your current certiicate, the fee is $10 ($20 if upgrading from Professional to Lifetime); after the initial 6 months the fee is $50 ($60 for Lifetime).

Education credit hours from a college/university are acceptable only if the college/university is accredited. For a list of accredited colleges/ universities, refer to the book Accredited Institutions of Postsecondary Education (Washington, DC: American Council on Education), which may be available in your local library or online at www.chea.org.

Payment Options:

Rush Process	Yes	No (Please include additional $25; will be processed in 5 business days.)
Check (included) for		$ ________________ U.S. funds	/	$ __________________ Canadian funds made payable to ACSI
Money Order (included) for $ ________________ U.S. funds			/	$ __________________ Canadian funds made payable to ACSI

Credit Card Type and Number: ________________________________________________________________________________

Expiration Date _____________________________________________________________________________________________

Cardholder’s name as it appears on the card _____________________________________________________________________

I authorize ACSI to charge my account in the amount of $ __________________ in U.S. funds.

Authorized Signature ________________________________________________________________________________________

Please read and complete your application carefully. If your application is incomplete for any reason other than the omission of transcripts that will be coming later from an educational institution, your materials will be returned to you with a note explaining what is lacking. A $10 processing fee must be included when resubmitting materials within 6 months of an incomplete application. Please do NOT staple or tape pages or payment. Please note that $10 of the application fee is nonrefundable.

ACSI Certiication Oice, PO Box 65130, Colorado Springs, CO 80962-5130

Phone: 719-528-1201, Fax: 719-867-0246, E-mail: certiication@acsi.org, Web: www.acsi.org