Step 1 of 9 11% Please use this form to submit your certification enrollment application.Certification you wish to apply for*Select your certificationCertified Personal Finance Counselor (CPFC)Certified Educator in Personal Finance (CEPF)Certified Consumer Debt SpecialistCertified Consumer Receivables CounselorCertified Residential Housing Counselor"I understand and agree that if I do not meet all eligibility criteria and Candidate Fitness Standards for certification my Application will be denied and that no refund will be granted. I also understand that an Applicant Pre-Screening Form has been made available so that I may determine for myself whether I meet all eligibility criteria and Candidate Fitness Standards for certification prior to the payment of any fees."* I Agree Certification Enrollment* Price: $549.00 Name* First Last Please complete all of the following fields with your personal/home contact information. We will request your work details on a following page.Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Employer Name (If self-employed, please enter your first and last name in this field)*Work Contact Information - Please complete all of the following fields with your work information. We will NOT send any communication, electronic or physical, to a work address unless you request it as your default mailing address.Job TitleWork Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Which address would you like any physical mail sent to?*HomeWorkWhich email would you like notifications sent to?*PersonalWork Have you ever been convicted of a felony?*YesNoPlease provide each date of conviction, the felony or felonies in question, and a description of the circumstances of the conviction.Have you ever had a professional license or certification related to the financial services, financial counseling or education field(s) revoked, suspended or otherwise subject to disciplinary action?*YesNoPlease provide each date of revocation, suspension or disciplinary action, the name of the licensing or certification body, and a brief explanation of the circumstances.Have you ever had a professional license or certification NOT related to the financial services, financial counseling or education field(s) revoked, suspended or otherwise subject to disciplinary action?*YesNoPlease provide each date of revocation, suspension or disciplinary action, the name of the licensing or certification body, and a brief explanation of the circumstances.Have you ever filed bankruptcy?*YesNoPlease provide each date on which you filed for bankruptcy and briefly explain the circumstances of the bankruptcy.Have you ever been or are you now subject to a judgment lien?*YesNoPlease provide each date a judgment lien has been issued against you, provide the jurisdiction in which the lien was issued, and briefly explain the circumstances of each judgment lien. An Applicant is required to have a minimum of 6 months work experience. Please provide a brief description of your work experience and the amount of time you spent in each field.* An Applicant or Certificant is required to have a minimum of a High School diploma or GED. Higher levels of education are preferred. An Applicant or Certificant must provide information about their highest level of formal education obtained, including the following information. Fincert.org reserves the right to verify reported information.I have obtained my High School diploma or GED*YesNoHighest degree level attained*Highest degree level attainedHigh School/GEDSome CollegeAssociates DegreeBachelors DegreeGraduate DegreeArea(s) of study*Institution from which degree was attained* Policy Review Affirmation*Yes"I have read and understand Fincert.org's Certification Policies and Standards. I understand that these Certification Policies and Standards are subject to change at any time, with or without notice, and that I am solely responsible for ensuring that I review any updates to these Certification Policies and Standards when they are published.Application, Renewal and Recertification Procedure Review Affirmation*Yes"I have read and understand Fincert.org's procedures, including but not limited to the Application, Renewal and Recertification Procedures. I understand that these procedures are subject to change at any time, with or without notice, and that I am solely responsible for ensuring that I review any updates to these procedures when they are published."Continuing Education Affirmation*Yes"I understand that after becoming certified through Fincert.org, I will be required to complete continuing education unit requirements. I have read and understand Fincert’s procedures, including but not limited to the CEU Procedures. I understand that these procedures are subject to change at any time, with or without notice, and that I am solely responsible for ensuring that I review any updates to these procedures when they are published."Ethical Affirmation*Yes"I have read, understand and will abide by Fincert’s Code of Ethics, found in Article II of Fincert.org's Certification Policies and Standards, which I understand applies equally to both Applicants and Certificants. I further understand failure to abide by the Code of Ethics may be grounds for the immediate denial, suspension or revocation of certification."Professional Conduct Affirmation:*Yes"I have read, understand and will abide by Fincert’s Code of Professional Conduct, found in Article III of Fincert Certification Policies and Standards, which I understand applies equally to both Applicants and Certificants. I further understand failure to abide by the Code of Professional Conduct may be grounds for the immediate denial, suspension or revocation of certification."Background Check Notice*Yes"I understand that Fincert.org reserves the right to check my criminal, employment and education history including, without limitation, criminal/driving records, references, and release of licensing and investigatory information possessed by any state, local, or federal agency. These checks may be conducted, with or without cause, at any time during the thirty-six month period following the submission of an Application for Certification or Application for Renewal of Certification. I hereby agree to provide such additional information, signed waivers or other such assistance as Fincert may from time to time request from me to conduct these background checks. I further acknowledge and agree that failure to provide such additional information or assistance shall constitute grounds for immediate denial, suspension or revocation of certification."No Employment or Agency*Yes"I understand that acceptance of this Application and/or certification by Fincert.org does not constitute an offer of employment with Fincert.org or any form of agency on its behalf."Fees Non-Refundable*Yes"I understand that any fees paid to Fincert.org with the submission of this Application, as well as any fees paid in the future for renewal, recertification, or for any other purpose, are completely non-refundable."Regulatory Reporting*Yes"I understand that Fincert.org may provide information about Applicants or Certificants to regulatory authorities and others upon request, or as otherwise required by law."Affirmation of Accuracy*Yes"By submitting this Application, I state that the information provided on this Application and any other information that I have provided is accurate and true to the best of my knowledge and ability to determine. Further, I understand that providing inaccurate information to Fincert.org or its authorized representative(s) may be grounds for immediate denial or revocation of certification without refund.""I have read this Application Form carefully, and I understand the meaning of its provisions and agree to abide by them."*Enter your full name as your electronic signature. Total $0.00 Payment TypeI will make payment online todayI will make payment by phoneMy employer or card holder has, or will, make payment by phoneCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name