The PMI Certification Renewal form serves as a crucial document for professionals seeking to maintain their PMI certifications. This comprehensive form allows individuals to apply for recertification by confirming their personal and professional details, checking if a name change has occurred, and providing a home and employer address. A unique PMI ID number alongside other credentials is required to complete the form. To ensure the credential remains current, individuals must fulfill their Continuing Education Units (CEU) requirements and submit accompanying CEU documentation along with the renewal fee. The form outlines a structured process for listing all relevant continuing education activities, attaching copies of supporting documentation, and specifies fees for renewing multiple certifications within the same calendar year, as well as late fees for overdue renewals. Payment methods are detailed, accommodating various channels including online payments and mail, with a strong emphasis on submitting copies of documentation and payment receipts to avoid processing delays. Furthermore, the form offers guidance for those with expired certificates seeking reinstatement, underscoring the form's role in facilitating continued professional development and certification validity.
| Question | Answer |
|---|---|
| Form Name | Pmi Certification Renewal Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | PMI, credential, seminole tribe of florida environmental resource management department permits, TX |
PMI CERTIFICATION RENEWAL FORM
PMI CERTIFICATION: (check renewals only) CMC CMIS CMOM CMCO
NAME
CHECK IF THIS IS A NAME CHANGE. PREVIOUS NAME
HOME STREET ADDRESS
CITY
PHONE NUMBER
()
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PMI ID# |
OTHER CREDENTIALS |
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PO BOX OR APARTMENT NUMBER
STATEZIP CODE
CELL PHONE NUMBER
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EMAIL ADDRESS |
FAX NUMBER |
EMPLOYER/ORGANIZATION NAME
JOB TITLE
STREET ADDRESS
PO BOX OR SUITE NUMBER
CITY
MAIN PHONE NUMBER
()
SPECIALTY
STATEZIP CODE
DIRECT LINE OR EXTENSION NUMBER
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EMAIL ADDRESS |
FAX NUMBER |
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PAYMENT OF RENEWAL FEE
Upon fulfillment of your CEU requirements, apply for recertification in order to keep your credential current by submitting CEU documentation, renewal fee, and this completed form to PMI. The renewal fee is $75. If you have more than one PMI certification, include additional fees as follows: $50 for the second and $25 each for the third and fourth certifications when renewing within the same calendar year (i.e., if you are renewing four PMI certifications in the same calendar year, the total fee is $175). A late fee of $50.00 is required if the renewal application and fees are received more than thirty days following the expiration date of the certificate(s). PMI accepts VISA, MasterCard and American Express payments online at www.pmiMD.com. Payments by check, money order and credit card are
accepted by mail. |
062212 |
Practice Management Institute |
800.259.5562 Toll free |
9501 Console Drive, Suite 100 |
210.691.8900 Phone |
San Antonio, TX 78229 |
www.pmiMD.com |
CEUs
LIST ALL CONTINUING EDUCATION ATTENDED AND/OR SUCCESSFULLY COMPLETED THAT IS RELEVANT TO YOUR CERTIFICATE TYPE AND ATTACH COPIES OF YOUR SUPPORTING DOCUMENTATION
DATE
1/1/12
METHOD
CLASSROOM
TRAINING
CATEGORY*
IL
TITLE/SUBJECT
SAMPLE ONLY
PROVIDER/EDUCATOR |
CEUs |
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EARNED |
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PMI |
3 |
CERTIFICATE
ATTACHED
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*TRAINING CATEGORY KEY: |
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TRAINING METHOD |
CATEGORY |
CEU Limit*** |
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Classroom |
IL |
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Instructor led, includes interactive Q&A |
No CEU limit |
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Webinar |
IL |
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Instructor led, includes interactive Q&A |
No CEU limit |
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Audio Conference |
IL |
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Instructor led, includes interactive Q&A |
No CEU limit |
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Online/web based programs |
IL |
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Instructor led; requires interaction with instructor |
No CEU limit |
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Audio, Video, or Web based Self Study |
SS = Self Paced, Independent Study without access to |
3 - 6 CEU limit per |
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instructor |
provider/program |
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***Refer to EARNING CEUS document for complete details
SEND TO: Practice Management Institute
MAIL: 9501 Console Drive, Suite 100, San Antonio, TX 78229
FAX: 210.691.8972
SCAN & EMAIL: info@pmiMD.com
NOTE:
•If mailing your application, send copies only of your CEU documentation as they will not be returned to you.
•A copy of the web payment receipt should accompany your application.
•Incomplete or illegible applications will not be processed.
•If your certificate expired a year or more ago, please contact PMI at 800.259.5562 for further guidance on how to reinstate a delinquent certification.
062212
Practice Management Institute |
800.259.5562 Toll free |
9501 Console Drive, Suite 100 |
210.691.8900 Phone |
San Antonio, TX 78229 |
www.pmiMD.com |