©2019. www.nccap.org
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National Certification Council for Activity Professionals
National Center for Montessori and Learning
3015 Upton Drive
Kensington, Maryland 20895 USA
HOME CARE CERTIFICATION APPLICATION (HCC)
Name:
Date of Birth: Last 4 of SS#: Phone:
Address:
City: State: ZIP Code:
Email: Today’s date:
EMPLOYMENT INFORMATION
Current employer:
Employer address: How long?
Phone: E-mail: Fax:
City: State: ZIP Code:
Position:
SUPPORTING DOCUMENTATION TO BE ATTACHED TO THIS APPLICATION (INITIAL EACH BOX)
I have included a copy of either my GED, High School Diploma or official college transcript
I have included a letter stating the number of hours of work experience on company letterhead and with the contact person
of the company. Requirement: at least 6 months and/or 1000 hours of experience
I have included copies of certificates of Continuing Education (CE) for a total of 10 hours
I have included a copy of my HCC Course Completion Certificate
I have included my $30.00 payment for HCC application and understand that Certification is good for 1 year and must be
renewed annually by submitting 20 additional Continuing Education (CE) hours and paying the $30 renewal fee
Example of acceptable experience letters and certificates for Continuing Education (CE) are provided for your reference.
DO NOT SEND ORIGINALS
1
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STEP: CREATE A PRIVATE AND SECURE INDIVIDUAL ONLINE ACCOUNT ON: WWW.NCCAP.ORG
2
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STEP: UPLOAD ALL REQUIRED APPLICATION DOCUMENTS INTO YOUR ONLINE ACCOUNT
OR SEND VIA US MAIL TO: NCCAP, 317 Office Square Lane, Suite 202A, Virginia Beach, VA 23462
FOR ASSISTANCE: (757) 552-0653 or Email: info@nccap.org
PAYMENT
PAYABLE TO: National Certification Council for Activity Professionals or NCCAP.
CREDIT CARD: Pay through our secure online payment portal on www.nccap.org.
US MAIL: Check, Cashier’s Check or Money Order. Do not send cash.
If your check is returned for insufficient funds, a fee will be charged of $60.
PLEASE READ AND SIGN BELOW
©2019. www.nccap.org
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National Certification Council for Activity Professionals
National Center for Montessori and Learning
3015 Upton Drive
Kensington, Maryland 20895 USA
DISCLAIMER
The Standards and Certification programs of NCCAP have been developed and revised through years of surveying
and research. By applying for Certification, the applicant agrees to comply by and with these Standards. By
applying for Certification, the applicant expressly waives any right of law for redress or compensation due to
failure to obtain Certification by NCCAP. Applicant acknowledges NCCAP Certification as voluntary and that
applicant’s failure to obtain Certification does not affect his or her right to obtain gainful employment.
DECLARATION
I acknowledge that it is my responsibility:
1.
To keep NCCAP informed of any name, address or email change.
2.
To keep my Certification current by or before the expiration date.
I acknowledge that:
1.
After completion of course requirements, I have sixty (60) days in which to submit my application form,
required documentation and applicable fees for Certification.
2.
After the expiration date of my Certification, I have sixty (60) days in which to submit my application form,
required documentation and applicable fees for Renewal of my Certification.
3.
If I am delinquent in my submission, NCCAP applies the following policy:
A.
My file will be kept for one (1) calendar year during which time I may complete any outstanding
requirements for Certification or Renewal.
B.
I am not permitted to use my Certification title or claim until it is formally issued or renewed by
NCCAP, nor during the time it has expired.
C.
My Certification will be suspended after the expiration date for Renewal and my name removed from
the NCCAP registry.
D.
If I fail to respond within one (1) year after expiration of my renewal date and want to become
Certified, I must resubmit all required documentation to verify compliance with Certification
standards and fees.
I acknowledge that falsification or misrepresentation of information or supporting documentation at any time
during the Certification process will lead to NCCAP’s refusal to certify me. By signing below, I consent to NCCAP
checking references, verifying information, and obtaining any other reports it may deem necessary to evaluate my
application.
I agree that by signing this Declaration, I hold NCCAP harmless from any result of such reference checks.
Applicant’s Name (printed):
Applicant’s Signature: Date
©2019. www.nccap.org
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National Certification Council for Activity Professionals
National Center for Montessori and Learning
3015 Upton Drive
Kensington, Maryland 20895 USA
SAMPLE LETTER OF EXPERIENCE
This template must be completed, placed on company letterhead and signed by an authorized person who
verifies employment with your company. You must have a letter from each employer until you have satisfied
proof of 6 months and/or 1000 hours of experience.
Date Written:
Applicant’s Name:
Agency Name:
Applicant’s Title:
Agency Address:
City: State: Zip:
Name and Title of Supervisor:
Employment: From to
(Month / Day / Year) (Month / Day / Year)
Check: Full-time Number of Hours per week:
Check: Part-time Number of Hours per week:
TOTAL HOURS WITHIN LAST 5 YEARS:
Signature and Title of person authorized to verify employment:
Name (print):
Title (print):
Signature:
Date:
(Month / Day / Year)
