Recertification Application

Academy of Certified Birth Educators & Labor Support Professionals
For office use only: Recertification granted: __________ mailed: __________	2001 East Prairie Circle, Suite I Olathe, KS 66062-5419 800-444-8223 / 913-782-5116 FAX: 913-397-0933
Recertification Application
Name:
Address:
City/State:	Zip:
Home#:	Work#:
Place of Employment:
Email:
Original Course Location:
Original/Last Certification Date:
Are you an independent instructor or on staff at a hospital?:
Number of couples taught this year:

Recertification is required by ACBE every two years to stay in good standing with the Academy even if your Employer does not require it.

This application must be submitted with outline, fee, and requirement a, b, c, or d

Requirements

All members must submit current class outline in the enclosed online format. Outlines not in this format will no longer be accepted.
What changes have you made on your outline since your last Recertification?

___________________________________________________________________________________________
$45.00 for a 2-year Recertification Renewal Fee.
Choose one of the following:
- a. Fifteen contact hours (CEU's) in a two-year period directly or indirectly related to childbirth (please send copies) $45.00
- b. Submit three book reviews of current books relating to childbirth education and a case study of a challenging class situation you have had. Please relate the problem or situation and how you dealth with it. $45.00
- c. Attend one day at an ACBE site for recertification. $45.00
- d. Attend one day at an ACBE site for recertification plus receive 7.7 CEUs. $80.00
- e. I have already recertified for my two-year period but would like to attend the one day at an ACBE site for the 7.7 CEUs. $35.00

Location(Site city and state): ______________________ Date: __________

Please attach a short note to tell us how you're doing and about your classes. We would value an article by you which could be published in our newsletter. All educators benefit from sharing ideas, hearing how you handled an unusual situation in class, or a motivating story to brighten our day. Having your article published can benefit you as well.

Do we have permission to print any of the following in our newsletter?
Book report _______ Case Study _______ or any comments _______

How can the Academy help you? ______________________________________________

How would you like your name printed on the certificate? _________________________

Payment Method

Include your check or money order, made payable to: Academy of Certified Birth Educators, or credit card information as indicated below. You can also pay online with Paypal. Please see our website for details.

Check or Money Order: Amount enclosed $ __________________

Credit Card: MasterCard Visa Discover (circle one)
Account# ____________________________________ Exp. ____________

Signature ___________________________________
To process, signature and expiration date are required.

This file last modified 03/03/07