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Commission for Case Management Certification Incomplete Applications (9/10/10 deadline)
Mr pencil

How would you like your name to appear on your certificate?



Agreement
By completing this form, you attest that you have attended the activity in its entirety.
Please indicate the the relevance of the following factors on your decision not to submit your application for the CCM® examination to be held in December 2010.
I thought I did submit my application.
I ran out of time to get everything done.
My license doesn't allow for independent practice.
My license is not appropriate for case management practice
My license has expired/is on probation.
I don't have enough employment experience.
I have the 12 months of appropriate employment experience but my supervisor is not a CCM®.
My employment experience is more than 10 years old.
I couldn't track down a previous employer to complete the Employer Verification Form.
I couldn't get my current employer to complete the Employer Verification form on time.
I do not have the appropriate educational background.
I am self employed and did not want to contact my clients to complete the Self Employment Verification forms.
I am self employed and was unable to get the Self Employment verification forms completed on time.
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.
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.
I could not afford the application fee.
I could not afford the exam fee.
The application is too confusing/too hard.  I gave up.
Other:  Please describe any other factor(s) that kept you from submitting your CCM® exam application.

How likely will you be to reapply for the CCM examination at any time in the future?

Mr question