NACE Application.pdf

NACE INTERNATIONAL

CERTIFICATION APPLICATION

Submit application to:

NACE International Certification Department 1440 South Creek Drive

Houston, TX 77084

Phone: 281/228-6211 Fax: 281/228-6311

e-mail: [email protected] Note: This application is for Corrosion Technician, Corrosion Technologist, Senior Corrosion Technologist, Materials Selection/Design Specialist, Protective Coating Specialist, Chemical Treatment Specialist and Corrosion Specialist applicants. Cathodic Protection certification applicants must complete a cathodic protection application available at www.nace.org or by contacting the Certification Department.

Certification Application

NACE International Certification Program

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DIRECTIONS 1. Make and keep a copy of your forms for your record. NACE INTERNATIONAL CAN ASSUME NO

RESPONSIBILITY FOR FORMS LOST IN TRANSIT. 2. All information requested on the accompanying forms must be legibly printed or typewritten in black

ink, suitable for photocopying.

NOTE: Application Forms that do not meet the standard of neatness and layout will be returned. 3. All information requested MUST be provided. 4. Completed forms must be accompanied by appropriate fees, made payable to NACE International, in

US funds. Use Section A.5 of this application to calculate applicable fees. NOTE: Appropriate Processing fees will be charged for each certification for which you apply. 5. Completed, legible, forms can be mailed to NACE International Headquarters, Certification

Department Attn; Marie Newton, 1440 South Creek Drive, Houston, TX 77084, USA, or faxed to 281/228-6311.

The following items are included and must be completed as part of your application: ITEM DESCRIPTION A. Application information A.1 Applicant name, address, and phone number A.2 Category of recognition sought A.3 Categories of recognition currently held A.4 Applicant affidavit A.5 Fee calculation worksheet A.6 Parallel Path information (if applicable) A.7 Names of your qualification references A.8 Other information B. Attestation - signed and dated C. Work Experience Documentation C.1 Work Experience Form 1: Summary of Corrosion Work Experience C.2 Work Experience Form 2: Individual Job Experience D. Qualification References (four forms provided)

D.1 Qualification References must have knowledge of your corrosion experience and abilities.

Proctor Agreement Form



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Important!! Before you mail this application, check to be sure you have done the following: Completely filled out this Application. Enclosed a check made payable to NACE International for the correct amount, in US funds, or, give

complete details under A.5 for credit card payment. All fees are non-refundable. Provided all information requested. Do not, however, submit documentation in excess of that requested.

Documentation in excess of that requested will not be considered as part of your application. Distributed Qualification Reference forms to at least two individuals who will complete and return the forms

to NACE International. Attached proof of NACE Education courses, (where applicable for Parallel Path applicants.) MAKE A COPY OF ALL PAGES OF THIS APPLICATION FOR YOUR RECORDS.

NACE International cannot be responsible, and accepts no

responsibility for delays caused by incomplete, inaccurate, or illegible

information.

Applications are processed strictly on a first-in, first processed basis.

No exceptions will be made.

All NACE exams are the sole possession of NACE International. Any copying or sharing of

any portions of the exam(s) without the express written consent of NACE International is

prohibited. In the event of suspected cheating, NACE has the right to invalidate exam

results, fail the applicant and prohibit applicant from pursing any NACE certification or

taking a NACE course/exam for a period of five (5) years or take such other action as

provided for by NACE policies and procedures. Determinations regarding cheating shall be

made in accordance with NACE policies and procedures, which NACE may amend in its

sole discretion. Applicants acknowledge and agree that they are subject to these terms and

conditions when taking any NACE exam.

All fees are non-refundable.



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A.1 Applicant name, address, phone and fax numbers

Last Name First Middle Home address Home Phone City State/Province Zip/Postal Code Country Business Name Business Phone Business Address City State/Province Zip/Postal Code Country Fax Address all future correspondence to the: Home Yes/No Business Yes/No Present Job Title: Member of NACE International since: Member Number: _______________ A.2 Category of recognition sought (check only one) Corrosion Specialist (includes P & G) please specify Chemical Treatment Specialist Materials Selection/Design Specialist Protective Coatings Specialist Senior Corrosion Technologist Corrosion Technologist Corrosion Technician Note: Applications for Cathodic Protection Certification Level 1 (CP Tester), Level 2 (CP Technician) and Level 3 (CP Specialist) are available at: www.nace.org (Education/Certification tab)

A.3 Categories of recognition currently held Corrosion Specialist Cathodic Protection Specialist Chemical Treatments Specialist Materials Selection/Design Specialist Protective Coatings Specialist Senior Corrosion Technologist Corrosion Technologist

Corrosion Technician None

http://www.nace.org/



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A.4 Applicant’s Affidavit: I certify that all information I have provided in order to apply for NACE certification is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to cancel further consideration of this application. I expressly authorize, without reservation, NACE, its representatives or employees to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application. I hereby waive any and all rights and claims I may have regarding NACE, its agents, employees or representatives, for seeking, gathering and using such information in the certification process and all other persons, corporations or organizations for furnishing such information about me.

Signature: Date: Printed Name: A.5 Fee Calculation Worksheet Write required fees in this column 1. Processing fee NACE International Members - $100.00

Nonmembers - $250 ALL APPLICATION FEES ARE NON-REFUNDABLE NOTE: Processing fees are payable on each category for which you apply. 2. Examination fees (NACE International Members and Nonmembers) Corrosion Specialist ($150)

Protective Coatings Specialist ($150) Materials Selection/Design Specialist ($150)

Chemical Treatments Specialist ($150) Senior Corrosion Technologist ($150) Corrosion Technologist ($100)* Corrosion Technician ($100)*

Add up the total fee due: Please pay this amount in US funds $ Examination payment is not necessary if applying for certification through Parallel Path. (include copy of certificate)

Basic Corrosion - An Introduction date of course completion Internal Corrosion Course date of course completion ________________ Cathodic Protection - An Introduction date of course completion Coating Inspector Certification date of course completion Basic Protective Coatings & Linings date of course completion Cathodic Protection Theory & Data date of course completion Cathodic Protection Design I date of course completion Designing for Corrosion Control date of course completion Chemical Treatment for Corrosion Control (exam only – no course) CP Tester date of course completion CP Technician date of course completion CP Technologist date of course completion CP Specialist date of course completion

NOTE 1: Courses must have been completed within five years of the date of this application. NOTE 2: To expedite application please send copies of course certificates. Payment Method

Enclosed is a check, money order, or international bank draft payable in US funds to NACE. Credit Card (Check the appropriate one) American Express Discover Carte Blanche VISA MasterCard Diner’s Club Card Number: Expiration Date: Name on card: Signature: Application Date: ALL APPLICATION FEES ARE NON-REFUNDABLE



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NOTE: Any individual whose check for any fee is returned to NACE International as “uncollectible” for any reason will have to submit a new payment plus a “Returned Check Service Charge” of $25.00. Upon collection of the payment, the application process will resume. Examination fees must be paid before any examination may be taken, and processing fees must be paid before an application will be reviewed. Once submitted, the Application Fee is non-refundable and non-applicable to any other NACE International product or service. Examination fees are refundable if a refund is requested before an examination is taken. Once a particular examination has been taken, the fee for that examination is non-refundable and non-applicable to any other NACE International product or service. A.6 Parallel Path to Certification

Courses to be used toward parallel path to Corrosion Technician or Corrosion Technologist must have been taken within five years of the date the application is received at Headquarters. Proof of the courses should be submitted along with this application.

A.7 Qualification References

A qualification reference is a person who will vouch for your technical competence. Two Qualification References are required, four are recommended. You are asked to give the names of persons (unrelated to you and not more than one from your company) who have personal knowledge of your corrosion experience and abilities or of your teaching in a corrosion-related field. Acceptable references are registered engineers, present supervisor, present clients, previous supervisors, previous clients, professors and instructors, and NACE International Certificate holders of at least the same category for which you are applying.

NOTE 1: For Corrosion Technicians with only two years work experience, references from the same company may be accepted. However, this should be avoided if at all possible. NOTE 2: For Corrosion Specialist and Specialty Area applicants, one Qualification Reference must hold a NACE Certificate at the level being applied for or higher, a P.E. registration, ICorr Professional Member or international equivalent. NOTE 3: You are to send these individuals a Qualification Reference form (Item D), which they must complete and return directly to NACE International. This is your responsibility. You should follow up with these people to ensure that they correctly complete and return the Qualification Reference forms in a timely manner. Name #1 Name #2 Name #3 Name #4 (Optional) Please describe below any information which you wish to be considered by the Application Review Board

(such as, but not limited to: education [college, trade school], publications on corrosion subjects, other

technical papers or books that you have authored or co-authored, any patents you have obtained as a direct result of your efforts, etc.). You may attach a maximum of two, single sided pages of additional information if you desire. Attachments of more than two single-sided pages will not be reviewed.



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A.8 Other Information Engineering Registration: If you are applying for the category of Corrosion Specialist P, you must complete the following and attach a copy of your Engineering Registration certificate. State, Province, or Country: Date:

Certification Number: Specialty, if any: Is registration currently active? Yes No EIT Registration: Education Background: If you are applying for the category of Corrosion Specialist G, you must complete the following and attach a copy of your degree(s). Name of College or University Degree Received Date Awarded Student ID Number: _________________________ _________________________ Specialty Areas: If you do not hold NACE International Certification as a Senior Corrosion Technologist, please provide a copy of your qualification documentation.

MAKE A COPY OF ALL PAGES OF THIS

APPLICATION FOR YOUR RECORDS



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B. ATTESTATION I hereby: (1) Recognize and acknowledge that the proper control of corrosion can be critical to the safety and

welfare of the general public and industrial facilities. (2) Recognize and acknowledge that the control of corrosion is obligatory to maximize conservation of our

material resources, to reduce economic losses, and to protect the environment. (3) Recognize and acknowledge that the entire field of corrosion and its control encompasses the

application of the knowledge and experience of many diverse disciplines and levels of technical competence which must often be consulted.

(4) Recognize and acknowledge that only through continual association and cooperation with others in

this field can the safest and most economical solutions be found to the many corrosion problems. (5) Recognize and acknowledge that the quality of my work reflects on the entire profession of corrosion

control. For these reasons I:

(1) Agree to give first consideration in my corrosion control work to public safety and welfare and to protection of the environment.

(2) Agree to apply myself with diligence and responsibility to the corrosion control work that lies within my area of competence.

(3) Agree to pursue my work with fairness, honesty, integrity and courtesy, ever mindful of the best

interests of the public, my employer, and of fellow workers.

(4) Agree to not represent myself to be proficient or make recommendations in phases of corrosion control work in which I am not qualified by knowledge and experience.

(5) Agree to avoid and discourage untrue, sensational, exaggerated, and/or unwarranted statements regarding my work in oral presentations, written text, and/or advertising media.

(6) Agree to treat as confidential my knowledge of the business affairs and/or technical process of clients, employers, or customers when their interests so require.

(7) Agree to inform clients or employers of any business affiliations, interests, and/or connections which might influence my judgment.

(8) Agree to uphold, foster and contribute to the achievement of the objectives of NACE International. I understand that my failure to comply with these requirements could result in disciplinary action. Signature: Printed Name: Date:



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C. WORK EXPERIENCE DOCUMENTATION Directions 1. Carefully read these directions before proceeding 2. Make as many copies of Work Experience Form 2: Individual Job Documentation as you need to

document the work experience required. NOTE: For the purpose of these forms, “job” is defined as “a position in which you are/were regularly employed for a period of time.” For example: “I had a “job” for AAA Corrosion Company as a technician for two years.” Work performed as part of an education experience (e.g.; work study, summer jobs, graduate research, etc.) may be included. You may have more than one “job” per employer, for example, if you get promoted. “Acceptable work experience in responsible charge” is documented work experience in the field of corrosion

which includes: (a) the investigation of corrosion causes and mechanisms, (b) the investigation, design and implementation of corrosion control procedures, or (c) the teaching of corrosion related science, any of which should be at a level of responsibility requiring initiative, technical ability, and independent judgment. The applicant need not be in administrative or supervisory control of the work, however, it is necessary that the applicant be in technical control and have technical responsibility. The distinguishing characteristic of one in “responsible charge” of work in the corrosion field should be considered to be the ability to deal creatively with a set of circumstances relating to corrosion and to deduce or synthesize a fruitful and safe course of action. 3. Completely fill out one copy of Work Experience Form 2: Individual Job Documentation for each

job you want included in your work experience assessment. If you move from one “job” to another with the same employer, you must fill out separate forms for each “job”. You must provide complete information. If you are self employed, provide names and addresses of specific individuals who can verify your work history.

4. Summarize the information from each copy of Work Experience Form 2: Individual Job

Documentation you completed onto Work Experience Form 1: Summary of Corrosion Work Experience.

5. Arrange your forms in order of most recent experience first, followed by less recent experience.

Number pages consecutively. If you have 12 pages of forms the first page is page 1 of 12, and the other pages should be numbered 2 of 12 through 12 of 12.

6. Make a copy of all pages of this application for your records.



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C.2 WORK EXPERIENCE FORM 1: SUMMARY OF CORROSION WORK EXPERIENCE Page ____ of ____ Make and use as many copies of this form as needed. Please provide the information requested per the directions provided. Information must be printed in black ink or typed. Illegible information can seriously delay, even stop, your application process. Please summarize the information detailed on each copy of C.2 Work Experience Form 2: Individual Job Documentation. Begin with most recent experience.

Employment Dates Experience Employment Information From To Responsible Charge Other Mth/Yr Mth/Yr Yrs/Mths Yrs/Mths

Job Title: _____________ ____/____ ____/____ ____________________ _________ Company: ____________

Job Title: _____________

____/____ ____/____ ____________________ _________ Company: ____________ ______________________________________________________________________________________

Job Title: _____________ ____/____ ____/____ ____________________ _________ Company: ____________ ______________________________________________________________________________________





Job Title: _____________ ____/____ ____/____ ____________________ _________ Company: ____________ ______________________________________________________________________________________ You must indicate whether each individual period is “responsible charge” or “other”, it cannot be both.



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C.2 WORK EXPERIENCE FORM 2: INDIVIDUAL JOB EXPERIENCE Page ____ of ____ Use one of these forms for each period of work experience (“job”) you wish to document. Make and use as many copies of this form as you need. Please provide the information requested per the directions and definitions provided. ____________________________________________________________________________________ Job Information Applicant’s Name: ________________________ Who can NACE contact to verify this experience Job Title: _______________________________ Name: _________________________________ Company: ______________________________ Company: ______________________________ From: Month ______________ Year _______ Address: _______________________________ To: Month ______________ Year _______ State/Province: __________________________ Zip/Postal Code: _________________________ This work experience is requested to be considered As (check one of the following – it cannot be Phone: _________________________________ Counted as both): Fax: ___________________________________ __________ Responsible Charge __________ Other corrosion-related work E-mail: _________________________________

C.2 WORK EXPERIENCE FORM 2: INDIVIDUAL JOB EXPERIENCE Page ___ of ___ Describe in detail what are/were your corrosion related duties in this job. (Do not write on the back of this form). You may attach additional single sided sheets)

THIS SECTION MUST BE COMPLETED

Your application will be returned if this space is left blank ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________



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D. QUALIFICATION REFERENCE APPLICANT: Complete Items D.1, D.2, and D.3 then forward this form to the person you have listed in Item D.3. Ask this person to complete the remainder of the form and return it directly to NACE International. Qualification references may be submitted by the following, who have expertise in the corrosion field: Registered or chartered engineers Present and/or previous supervisor(s) of the applicant Present and/or previous professors/instructors of the applicant NACE International certificate holders. (For Corrosion Specialist and Specialty Area applicants, one

Qualification Reference must hold a NACE Certificate at the level being applied for or higher, a P.E. registration, ICorr Professional Member or international equivalent.)

D.1 Applicant’s full name: D.2 Certification category applied for: D.3 Name, title, company name, address, and phone number of person who is familiar with the work

experience of the applicant: Phone: REFERENCE: The applicant is applying for professional recognition by NACE International. Applicants for certification must meet specific requirements; please see the list of these requirements on the following page. Evaluation of an applicant’s qualifications also depends on assessment of professional experience by references. It is requested that you complete Items D.4 through D.13 on this form and return it directly to NACE. D.4 I hold NACE Certification as a: _____ Certified No.

_____ I am a Registered engineer (or equivalent)

_____ State/Province: ________________ Branch:__________ No:__________ Leave space blank if this section is not applicable D.5 I have known the applicant for _____ years. What is/was the nature of the association? Current Supervisor _____ Previous Supervisor _____ Current Client _____ Previous Client _____ Current Co-worker _____ Previous Co-worker _____ Current Professor/Instructor _____ Previous Professor/Instructor _____ Other _____(Please specify) D.6 From personal knowledge, my assessment of the applicant’s character and personal reputation is that

it is Excellent Average Below average D.7 From personal knowledge, I know that the applicant has been engaged in corrosion work for ___years.

(“corrosion work” being defined as “work in the field of corrosion at any level; the investigation of corrosion causes and mechanisms; and/or the investigation, design, and implementation of corrosion control procedures, and/or the teaching of corrosion-related science.”)

D.8 Based on this personal knowledge, I know that the quality of the applicant’s work in the field of corrosion is

Excellent Average Below average



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D.9 The applicant is proficient in the following phases of corrosion: D.10 Would you employ, or recommend the employment of, the applicant for employment in the phase of

corrosion work you have described in Item D. 9? Yes No D.11 Please describe any major projects/activities in which the applicant has been involved in the field of

corrosion work. Describe only those where you had personal knowledge of the applicant’s work. Please indicate the degree of responsibility exercised by the applicant, the complexity of the project/activity, the degree of knowledge/skill required, etc. (Attach a separate sheet)

D.12 Additional remarks or amplifying information: D.13 My signature below indicates that I have personal knowledge and expertise in the corrosion field upon

which to evaluate the applicant’s professional capabilities. Signature: Date: Printed Name: Return completed form to: NACE International, Certification Department, Attn Marie Newton, 1440 South Creek Drive, Houston, TX 77084-4906 USA Certification Title Work Experience and Education requirements for Certification

Corrosion Technician 2 years corrosion work experience

Cathodic Protection Tester 6 months cathodic protection work experience (recommended)

Cathodic Protection Technician 3 years cathodic protection work experience

Cathodic Protection Technologist 8 years cathodic protection work experience

Corrosion Technologist 4 years corrosion work experience

Internal Corrosion Technologist 4 years internal corrosion work experience and familiar with pipeline operations OR 2 years internal corrosion work experience with a degree in one of the following: Chemistry, Biology, Microbiology, Chemical Engineering, Metallurgical Engineering

Senior Corrosion Technologist 8 years corrosion work experience OR 4 years work experience with a bachelors degree in engineering or physical science

Specialty Areas Material Selection Design Chemical Treatment

Senior Corrosion Technologist certification OR 4 years coating experience with a bachelors degree in engineering or physical sciences AND an advanced degree in engineering or physical sciences that required a qualification exam.

Protective Coating Specialist 12 years coatings work experience OR 8 years w/SSPC Coatings Certification, NACE Coating inspector certification or Frozio certification.

Cathodic Protection 12 years cathodic protection work experience, including 4 years in responsible charge PLUS 2-year post-high school training in Math AND Science from an approved Technical/Trade School OR

6 year of cathodic protection work experience, including 4 years in responsible charge PLUS 4-year Physical Science or Engineering Degree OR

4 years cathodic protection work experience in responsible charge PLUS one of the following:

Bachelor’s degree in Engineering or Physical Sciences AND an advanced degree in Engineering or Physical Science that required a qualification exam

PE, PEng, or equivalent EIT registration or equivalent

Corrosion Specialist Specialty Area certification is required



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QUALIFICATION REFERENCE APPLICANT: Complete Items D.1, D.2, and D.3 then forward this form to the person you have listed in Item D.3. Ask this person to complete the remainder of the form and return it directly to NACE International. Qualification references may be submitted by the following, who have expertise in the corrosion field: Registered or chartered engineers Present and/or previous supervisor(s) of the applicant Present and/or previous professors/instructors of the applicant NACE International certificate holders. (For Corrosion Specialist and Specialty Area applicants, one












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D. QUALIFICATION REFERENCE APPLICANT: Complete Items D.1, D.2, and D.3 then forward this form to the person you have listed in Item D.3. Ask this person to complete the remainder of the form and return it directly to NACE International. Qualification references may be submitted by the following, who have expertise in the corrosion field: Registered or chartered engineers Present and/or previous supervisor(s) of the applicant Present and/or previous professors/instructors of the applicant NACE International certificate holders (For Corrosion Specialist and Specialty Area applicants, one












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D. QUALIFICATION REFERENCE

APPLICANT: Complete Items D.1, D.2, and D.3 then forward this form to the person you have listed in Item D.3. Ask this person to complete the remainder of the form and return it directly to NACE International. Qualification references may be submitted by the following, who have expertise in the corrosion field: Registered or chartered engineers Present and/or previous supervisor(s) of the applicant Present and/or previous professors/instructors of the applicant NACE International certificate holders (For Corrosion Specialist and Specialty Area applicants, one












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D. QUALIFICATION REFERENCE

APPLICANT: Complete Items D.1, D.2, and D.3 then forward this form to the person you have listed in Item D.3. Ask this person to complete the remainder of the form and return it directly to NACE International. Qualification references may be submitted by the following, who have expertise in the corrosion field: Registered or chartered engineers Present and/or previous supervisor(s) of the applicant Present and/or previous professors/instructors of the applicant NACE International certificate holders (For Corrosion Specialist and Specialty Area applicants, one












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PROCTOR AGREEMENT CERTIFICATION EXAMINATION

CORROSION TECHNICIAN OR CORROSION TECHNOLOGIST EXAM Third party proctors are eligible to proctor Corrosion Technician and Corrosion Technologist exams only.

Dear Applicant: Please complete the top portion of this form and forward this agreement to your chosen proctor. It is your

responsibility to ensure that this signed agreement is returned to NACE International Headquarters. Your certification examination will not be mailed until this agreement has been received by the NACE International Certification Department. Please complete the following: Examination Category: Examination Date: Name of Proctor: Applicant’s Statement: I certify to the best of my knowledge and belief that the following statements are true: That the chosen proctor holds NACE International Certification at the level of exam being proctored or higher, or is a registered Professional Engineer (or equivalent), that I have no business affiliation with my chosen proctor, that I will make no copies of the examination in part or whole, that I will not accept assistance from any other person to complete the examination, and that I will not keep the examination longer than the time permitted. All NACE exams are the sole possession of NACE International. Any copying or sharing of any portions of the exam(s) without the express written consent of NACE International is prohibited. In the event of suspected cheating, NACE has the right to invalidate exam results, fail the applicant and prohibit applicant from pursing any NACE certification or taking a NACE course/exam for a period of five (5) years or take such other action as provided for by NACE policies and procedures. Determinations regarding cheating shall be made in accordance with NACE policies and procedures, which NACE may amend in its sole discretion. Applicants acknowledge and agree that they are subject to these terms and conditions when taking any NACE exam.

Applicant’s Signature: Date: Applicant’s Printed Name and Address Name: Company: Address: City, State, Zip: Phone: PROCTOR: Please complete the remaining portion of the agreement and return the completed form to NACE International Headquarters. Proctor’s Statement:

I certify to the best of my knowledge and belief that the following statements are true: That I hold NACE International Certification at the level of exam being proctored or higher, or am a registered Professional Engineer (or equivalent), or am a foreign consulate or diplomat in the consulate's office and that I have no business affiliation or perceived conflict of interest with the above-named applicant, that I will allow no copies of the examination to be made in part or whole,

that I will ensure that the above-named applicant is the person who will complete the examination, and that the applicant will complete the examination without the assistance of a third party, and within the time limit permitted. Violation of this agreement may result in a suspension or revocation of NACE International Professional Recognition.

Proctor’s Signature: Date Certification Held/Certification Number __________ Registered P.E. Number/State __________ Proctor’s Printed Name and Address Name: Company: Address: City, State, Zip (PE stamp/seal) Phone: Return form to: NACE International Certification Dept. Attn Marie Newton, 1440 South Creek Drive, Houston, TX 77084, USA



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PROCTOR AGREEMENT INHIBITOR, CP TESTER UPGRADE, SENIOR CORROSION TECHNOLOGIST, SPECIALTY AREA,

OR CORROSION SPECIALIST CERTIFICATION EXAMS

Proctors for all exams EXCEPT for Corrosion Technician and Corrosion Technologist certification exams must meet ALL of the following requirements:

1) be a member in good standing for at least 10 years; 2) hold active NACE Corrosion Specialist certification for at least 5 years and; 3) be an active NACE participant at the national level currently serving as an officer in an Area or Section, OR an officer of a TCC STG or a TCC technology coordinator, OR an officer of a NACE professional development committee, OR a NACE board member, OR a NACE Past President. Part I - Dear Applicant: Please complete Part I of this form and forward this agreement to your chosen proctor. It is your responsibility to

ensure that this signed agreement is returned to NACE International Headquarters. Your certification examination will not be mailed until this agreement has been received by the NACE International Certification Department. Please complete the following: Examination Category: Examination Date: Name of Proctor: Applicant’s Statement: I certify to the best of my knowledge and belief that the following statements are true: That the chosen proctor meets ALL of the above stated proctor requirements, that I have no business affiliation with my chosen proctor, that I will make no copies of the examination in part or whole, that I will not accept assistance from any other person to complete the examination, and that I will not keep the examination longer than the time permitted. All NACE exams are the sole possession of NACE International. Any copying or sharing of any portions of the exam(s) without the express written consent of NACE International is prohibited. In the event of suspected cheating, NACE has the right to invalidate exam results, fail the applicant and prohibit applicant from pursing any NACE certification or taking a NACE course/exam for a period of five (5) years or take such other action as provided for by NACE policies and procedures. Determinations regarding cheating shall be made in accordance with NACE policies and procedures, which NACE may amend in its sole discretion. Applicants acknowledge and agree that they are subject to these terms and conditions when taking any NACE exam.

Applicant’s Signature: Date: Applicant’s Printed Name and Address Name: Company: Address: City, State, Zip: Phone:

PART II - PROCTOR:

Please complete the remaining portion of the agreement and return the completed form to NACE International Headquarters.

Proctor’s Statement:

I certify to the best of my knowledge and belief that I meet ALL of the above stated proctoring requirements, or am a foreign consulate or diplomat in the consulate's office and that I have no business affiliation or perceived conflict of interest with the above-named applicant, that I will allow no copies of the examination to be made in part or whole, that I will

ensure that the above-named applicant is the person who will complete the examination, that the applicant will complete

the examination without the assistance of a third party, within the time limit permitted and that candidate(s) taking examination(s) are in view at all times. Violation of this agreement may result in a suspension or revocation of NACE International Professional Recognition.

Proctor’s Signature: Date Certification Held/Certification Number __________ Registered P.E. Number/State __________ Proctor’s Printed Name and Address Name: Company: Address: City, State, Zip (PE stamp/seal) Phone:

Return form to: NACE International Certification Dept. Attn Marie Newton, 1440 South Creek Drive, Houston, TX 77084, USA

NACE Application.pdf

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Transcript of NACE Application.pdf