CAPM Register FORM_Customer
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PMI pref ers that you appl y u sin g th e on lin e ce rtif ica tio n sy ste m at PMI.o rg CAPM Credential Application · P age 1 All information and documentation must be in English. Facsimile and scanned copies will not be accepted. Please use blue or black ink and print all information carefully i n the boxes using CAPITAL LETTERS. Y ou must complete all fields. Prefix (MR., MRS., MS., DR.) Middle Name PMI Member ID# Last Name (family name, surname). Candidates with only a single name should use last name field. Prefix (MR. , MRS., MS. , DR .) Firs t Name (given name) Middle Name First Name (given name) Middle Name First Name (given name) Last Name (family name, surname). Candidates with only a single name should use last name field. Suffix Suffix Suffix Prefix (MR., MRS., MS., DR.) Last Name (family name, surname). Candidates with only a single name should use last name field. If you are a member of PMI you have an ID number. Your ID number is on the membership card you received in your welcome kit when you joined. If you’ve lost your PMI member ID number you may contact PMI Customer Care at +1-610-356-4600, or send e-mail to [email protected]. Check here if same as above. Check here if same as above. Section 1. Name for correspondence from PMI: Section 2. Name on government-issued identification: Section 3. Name for your CAPM certificate: Instructions: In this section you are being asked to PRINT your name for t hree separate purposes. It is very important that you complete this section carefully . Section 1. Please print your name as you wish to be referred to in correspondence from PMI. Section 2. Please print your name as it appears on your government-issued identification that you will present at the testing center. Section 3. Please print your name as you wish it to appear on your CAPM certificate. Home Address Business Name Business Address Contact information: Preferred Mailing Address: Home Business Billing Address*: Home Business *If paying by credit card, your billing address must match the address on your credit card statement. City Zip/Postal Code State/Province/Territory City Zip/Postal Code State/Province/Territory Country
Transcript of CAPM Register FORM_Customer
8/12/2019 CAPM Register FORM_Customer
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CAPM Credential Application · Page 1
All information and documentation must be in English. Facsimile and scanned copies will not be accepted.
Please use blue or black ink and print all information carefully in the boxes using CAPITAL LETTERS. You must complete all fields.
Prefix (MR., MRS., MS., DR.)
Middle Name
PMI Member ID#
Last Name (family name, surname). Candidates with only a single name should use last name field.
Prefix (MR., MRS., MS., DR.) First Name (given name)
Middle NameFirst Name (given name)
Middle NameFirst Name (given name)
Last Name (family name, surname). Candidates with only a single name should use last name field. Suffix
Suffix
Suffix
Prefix (MR., MRS., MS., DR.)
Last Name (family name, surname). Candidates with only a single name should use last name field.
If you are a member of PMI you have an ID number. Your ID number is on the membership card you received in
your welcome kit when you joined. If you’ve lost your PMI member ID number you may contact PMI Customer
Care at +1-610-356-4600, or send e-mail to [email protected].
Check here if same as above.
Check here if same as above.
Section 1. Name for correspondence from PMI:
Section 2. Name on government-issued identification:
Section 3. Name for your CAPM certificate:
Instructions:In this section you are being asked to PRINT your name for three separate purposes. It is very important that you complete this section carefully.
Section 1. Please print your name as you wish to be referred to in correspondence from PMI.
Section 2. Please print your name as it appears on your government-issued identification that you will present at the testing center.
Section 3. Please print your name as you wish it to appear on your CAPM certificate.
Home Address
Business Name
Business Address
Contact information:
Preferred Mailing Address: Home Business Billing Address*: Home Business*If paying by credit card, your billing address must
match the address on your credit card statement.
City Zip/Postal CodeState/Province/Territory
City Zip/Postal CodeState/Province/Territory
Country
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CAPM Credential Application · Page 2
High School Diploma / Global Equivalent
Associate’s Degree / Global Equivalent
Bachelor’s Degree / Global Equivalent
Master’s Degree / Global Equivalent
City Zip/Postal CodeState/Province/Territory
Country
Address
Year diploma/degree was awarded
Field of Study:
Doctoral / Global Equivalent
Name of High School, College or University
EDUCATION ATTAINED (highest level attained at the time of this application)
Computer Science Education Engineering Finance Liberal Arts Marketing
Science Mathematics Economics Communications Other:
Applicant’s Primary Industry:
Aerospace
Automotive
Business
Communications
Construction
Consulting
Education
Engineering
Finance
Healthcare
Human Resources
Information Technology
Manufacturing
Pharmaceuticals
Telecommunications
Other:
Preferred E-mail: Personal Work
Preferred Phone: Home Business Mobile
Preferred Fax: Home Business
Area/State/City CodeCountry Code Phone Number Extension
Area/State/City CodeCountry Code Fax Number
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CAPM Credential Application · Page 3
Experience Verification Form - Part I
Project Title
Organization Address
Your Job Title Organization Name
Organization Address (continued)
Organization Address (continued)
Use the Experience Verification Forms (Parts I and II) to document at least 1,500 hours of project team experience. Alternatively, you may
skip this section and document 23 contact hours of project management education/training on the Project Management Education Form.
Number your projects and submit one set of Experience Verification Forms per project. Please photocopy these forms if you require additional space.
City Zip/Postal CodeState/Province/Territory
Country
First Name (given name) Last Name (family name, surname)
E-mail address
Contact Relationship
Please identify and provide current information for your primary contact on this project so that PMI can verify your professional work experience.
Project Sponsor Manager/Supervisor Project Manager Client Primary Stakeholder
Project #
Start Date (MM/YYYY)
/
Completion Date (MM/YY
/
Area/State/City CodeCountry Code Phone Number Extension
Area/State/City CodeCountry Code Phone Number Extension
Project Contributor
Supervisor
Manager
Project Leader
Project Manager
Project Role (check one box):
Educator
Consultant
Administrator
Other:
Primary Industry (check one box):
Aerospace
Automotive
Business
Communications
Construction
Consulting
Education
Engineering
Finance
Healthcare
Human Resources
Information Technology
Manufacturing
Pharmaceuticals
Telecommunications
Other:
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CAPM Credential Application · Page 4
Experience Verification Form - Part II
Project #
Initiating Processes,
Planning Processes,
Executing Processes,
Controlling Processes,
Closing Processes,
Total Hours for Project:,
Total the number of hours you applied to each project management process group during your project management team experience. (A total
number of 1,500 hours is needed to meet the eligibility requirement). Then, by process, summarize your project team experience on each
project. Candidates are required to complete this form. Attachments (e.g., scope of work documents) will not be accepted. Remember to record
the project number that corresponds with the project documented in Part I of the Experience Verification Form.
Initiating
Planning
Executing
Monitoring and Controlling
Closing
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CAPM Credential Application · Page 5
Education Form
A. PMI Registered Ed ucation Provid ers (R.E.P.s)*
University/college academic and continuing education programs
B. PMI Component organizations*
C. Employer/company-sponsored programs
D. Training companies or consultants
E. Distance-learning companies,including an end of course assessment
F. University/college academic and continuing education programs
The following education does not satisfy the education requirements:
• PMI chapter meetings
• Self-study (e.g., reading books)
You are only required to complete this form if you have not documented 1,500 hours of project team experience. Please photocopy this formif you require additional space.
Please document 23 contact hours of project management education/training. One contact hour is equal to one hour of participation in an educational activity. These hours must be related to project management and can include content on project quality, scope, time, cost, human resources, communications, risk, procurement, or integration management. Courses, workshops and training sessions offered by one
or more of the following education providers apply.
Course Title
Institution Name
Contact Hours Earned
Course Start Date (MM/DD/YYYY)
/ /
Course Completion Date (MM/DD/YYYY)
/ /
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Course Title
Institution Name
Contact Hours Earned Category (Please select A through F from the listing above.)
Course Start Date (MM/DD/YYYY)
/ /
Course Completion Date (MM/DD/YYYY)
/ /
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*Courses offered by PMI R.E.P.s, PMI Components (chapters, specific interest groups, colleges), or PMI, are preapproved for contact hours in fulfillment of eligibili ty requirements.
