PMP Certification Application

PMP Certification Application

PAGE 1 OF 6 | YOUR INFORMATION

Tips for completing this form:

• Hand-write your information clearly in blue or black ink onto a printed form and submit it by postal mail.

• Type your information into the PDF. If you have PDF-editing software like Adobe Acrobat or Foxit Reader, you can save your data.

Otherwise, you will only be able to type your information, then print out the form and send it to PMI.

All information and documentation must be in English. Faxed or scanned copies will not be accepted.

PMI Member ID#:

For PgMP credential holders:

If you hold the PgMP, you can maintain both credentials by accruing and reporting 60 PDUs within your three-year cycle.

Select one of the following options if you hold the PgMP.

Option A - PMP credential and PgMP credential will share PDUs.

Option B - PMP credential and PgMP credential will share PDUs going forward.

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 PMP certificate.

Section 1. Name for correspondence from PMI:

Section 2. Name on government-issued identification:

Check here if same as above.

Section 3. Name for your PMP certificate:

Check here if same as above.

Preferred Mailing Address: Home Business Billing Address*: Home Business

PMI Member ID#:

PAGE 2 OF 6 | YOUR INFORMATION (Continued)

Preferred E-mail: Personal Work Preferred Phone: Home Business Mobile

Preferred Fax: Home Business

Applicant’s Primary Industry:

Aerospace Construction Finance Manufacturing

Automotive Consulting Healthcare Pharmaceuticals

Business Education Human Resources Telecommunications

Communications Engineering Information Technology Other:

Highest level of education attained at the time of this application:

High School Diploma / Global Equivalent Associate’s Degree / Global Equivalent Bachelor’s Degree / Global Equivalent

Master’s Degree / Global Equivalent Doctoral / Global Equivalent

Did you graduate from a GAC-Accredited University? Yes No, I attended another University

Field of Study:

Communications Engineering Marketing Science

Computer Science Finance Mathematics Other

Education Liberal Arts Pharmaceuticals

PAGE 3 OF 6 | EXPERIENCE VERIFICATION

Primary contact on this project:

Contact Relationship: Project Sponsor Manager/Director Client Primary Stakeholder

Provide hours spent on each process group:

PAGE 4 OF 6 | EDUCATION

Please document 35 contact hours of project management education/training.

PAGE 5 OF 6 | GENERAL INFORMATION

Please include me in: Communications from PMI regarding its products, events and services Third Party Mailing Lists

Optional Information

Reason you are applying for this certification: Employer Required Employer Suggested Personal Development

Have you taken a certification preparation course presented by a PMI Chapter? Yes No

Have you taken PMI’s Applying the Fundamentals of Project Management? Yes No

Check here if you have special needs which may impair your ability to take the examination.

Language Aid for Examination

Arabic German Korean Turkish

Chinese (Simplified) Hebrew Portuguese (Brazilian) Chinese (Traditional)

Italian Russian French Japanese Spanish

I have read and understand all the policies and procedures in the Certification Handbook.

I have read and accept the terms and responsibilities outlined in the PMI Code of Ethics and Professional Conduct and in the PMI Certification Application/Renewal Agreement.

I declare that all the information I have provided on all pages of this application is true and accurate.

I understand that I must complete any coursework prior to sitting for the exam.

I understand that I may be selected for audit at any time.

PAGE 6 OF 6 | PAYMENT

Applicants are encouraged to apply using the online certification system, but may elect to pay the fees under separate cover.

PMI Member ID#:

Payment Options

Check MasterCard Visa Bank Transfer American Express Diners Club Discover

Examination Fees

Computer-Based Testing – member Computer-Based Testing – nonmember

Paper-Based Testing – member Paper-Based Testing – nonmember

Site Group Testing No. Date

Canadian resident tax Total

Certification Examination Special Accommodations Form

If you require special accommodations related to a disability in order to take the examination, please complete this section.

Which certification examination are you planning to take at this time? CAPM PMP PgMP PMI-RMP PMI-SP PMI-ACP PfMP

Please identify the disability:

Please list the special testing accommodation requested:

Certification Reexamination Form

Please print your name as it appears on your government-issued identification.

Reexamination Fees

Select the appropriate administration option and enter the total fee.

Computer-Based Testing – member Computer-Based Testing – nonmember Paper-Based Testing – member Paper-Based Testing – nonmember

Site Group Testing No. Date

Canadian resident tax Total

I am requesting the same special accommodation(s) that was approved for my previous examination.

I am requesting special accommodation(s) for the first time.

Language Aid for Examination

Arabic Chinese (Simplified) Chinese (Traditional) French

German Hebrew Italian Japanese

Korean Portuguese (Brazilian) Russian Spanish Turkish