REQUEST FOR CERTIFICATION APPLICATION
Click above to download printable version.

If you are interested in receiving an application for Prevention Certification, please complete this form and send it with appropriate fee to:

SCAPPA Certification Commission, PO Box 1763, Columbia, SC 29202, (803) 252-1087

Name: ___________________________________ Address: _______________________________________

City: _____________________________________ State: __________________ Zip Code: _______________

Phone: (W) _________________________________ (H) ___________________

E-mail: _____________________________________ Fax: __________________

Employer/School: _____________________________ Job/Position: __________________________________

• Certified Prevention Professional
• Certified Senior Prevention Professional

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