Commission for Case Management Certification Incomplete Applications (4/15/10 deadline)
How would you like your name to appear on your certificate?
Profession
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CCM
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Agreement
By completing this form, you attest that you have attended the activity in its entirety.
I agree
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Please indicate which, if any, of the below reasons influenced your decision not to complete your application for the CCM® examination.
I thought I did submit my application.
Yes
No
I ran out of time to get everything done.
Yes
No
My license doesn't allow for independent practice.
Yes
No
My license is not appropriate for case management practice
Yes
No
My license has expired/is on probation.
Yes
No
I don't have enough employment experience.
Yes
No
I have the 12 months of appropriate employment experience but my supervisor is not a CCM®.
Yes
No
My employment experience is more than 10 years old.
Yes
No
I couldn't track down a previous employer to complete the Employer Verification Form.
Yes
No
I couldn't get my current employer to complete the Employer Verification form on time.
Yes
No
I do not have the appropriate educational background.
Yes
No
I am self employed and did not want to contact my clients to complete the Self Employment Verification forms.
Yes
No
I am self employed and was unable to get the Self Employment verification forms completed on time.
Yes
No
I was going to have to answer one or more of the moral character questions (page 5) in the affirmative. I didn't want to disclose that information.
Yes
No
I was going to have to answer one or more of the moral character questions (page 5) in the affirmative. I figured that would get me denied.
Yes
No
I could not afford the application fee.
Yes
No
I could not afford the exam fee.
Yes
No
The application is too confusing/too hard. I gave up.
Yes
No
Other: Please describe any other factor(s) that kept you from submitting your CCM® exam application.
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Do you plan to reapply for the CCM examination at any time in the future?
Yes
No
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