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: (Work) __________________________________ (Home) __________________________________

E-mail: __________________________________________ Fax: ___________________________________

Employer/School: _____________________________ Job/Position: __________________________________

Please send an application for:

    o Certified Prevention Specialist
    o Certified Senior Prevention Specialist

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