ICCCP(F) APPLICATION

ICCCP Fellowship (F) Application

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Company

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International Certified Cost of Care Professional Fellow

Prior to applying, candidates may perform a credential eligiblity self-assessment or forward a current resume/CV to info@cvrp.ca to assess eligibility at NO COST.

Name*

First Last

Residential Address*

Street Address Address Line 2 City Province / State Postal Code / ZIP Country

Personal Phone*

Other Phone

Personal Email*

Emails are used to recover passwords & log into CVRP profiles. Once your first credential is approved, your Registration # will become your username.

Password*

Enter Password Confirm Password

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Employer Information

Employer Name*

Address*

Street Address Address Line 2 City Province / State Postal Code / ZIP Country

Work Email*

Work Phone

Work Cellular Number

Current Position*

ICCCP(F) Credential Eligibility Pathway

Only ONE credential submission is required below & proof must be attached.

Submit a CLCP or CCLCP or other life care planning credential in good standing.

Max. file size: 100 MB.

Submit proof of a CLCP or CCLCP, or other recognized life care planning credential in good standing; &/OR

Submit a CLCP or CCLCP or other life care planning credential in good standing.

Max. file size: 100 MB.

Submit proof of a CLCP or CCLCP, or other recognized life care planning credential in good standing; &/OR

Submit a CLCP or CCLCP or other life care planning credential in good standing.

Max. file size: 100 MB.

Submit proof of a CLCP or CCLCP, or other recognized life care planning credential in good standing; &/OR

3 of the 6 categories are Required & Must be Attached:

Applicants applying for ICCCP Fellowship, holding a CLCP, CCLCP, or other recognized life care planning credential in Good Standing, are NOT required to submit a redacted life care plan report for peer review.

1. Attach proof of confirmation of testimony as an expert witness in court in successfully defending life care plan(s); &/OR

Max. file size: 100 MB.

CVRP accepts softs copies but reserves the right to request a certified copy; &/OR

2. Attach proof of publication of a peer-reviewed article in a recognized publication; &/OR

Max. file size: 100 MB.

CVRP accepts softs copies but reserves the right to request a certified copy; &/OR

3. Attach proof candidate taught life care planning certification-related courses at or through a recognized institution; &/or

Max. file size: 100 MB.

CVRP accepts softs copies but reserves the right to request a certified copy; &/OR

4. Attach proof candidate made presentations as a subject matter expert at recognized conferences where a minimum of 8 certification education maintenance credit hours in total awarded (including credit for preparation hours) or would be eligible for awarding of CEUs; &/or

Max. file size: 100 MB.

CVRP accepts softs copies but reserves the right to request a certified copy; &/OR

5. Attach proof candidate has experience in peer-reviewing for life care planning credentialing; &/or

Max. file size: 100 MB.

CVRP accepts softs copies but reserves the right to request a certified copy; &/OR

6. Attach proof candidate participated in life care planning exam question development; &

Max. file size: 100 MB.

CVRP accepts softs copies but reserves the right to request a certified copy; &/OR

Volunteer to Sit the Examination

The exam is currently in beta for peer review to gather a substantial sample size. Successful ICCCP(F) applicants will receive 12 ICCCP CEUs for participating in the beta version of the life care planning examination. CEUs will be awarded once exam is completed.

I agree to complete the ICCCP exam in order to provide assistance in peer validation.*

The grade obtained on the examination does not impact the ICCCP(F) credential eligibility. The exam is currently in its beta phase for peer review to gather a substantial sample size. Successful ICCCP(F) applicants will receive 12 ICCCP CEUs for participating in the beta version of the life care planning examination. The CEUs will be awarded once exam is completed.

Do you require an accommodation to the examination?*

If you require an accommodation to sit the exam, briefly explain & submit documentation.

Upload Accommodation Documentation.

Max. file size: 60 MB.

CVRP accepts softs copies but reserves the right to request a certified copy.

Declaration

Regardless of outcome, have you ever been the subject or recipient of a complaint of professional negligence through membership in a professional association or registration in a related field?*

Yes

No

If yes, please explain:

Are you now the subject of any type of investigation, inquiry or proceeding by a professional licensing body or professional association relating to your professional conduct, competence, capacity or any other aspect of your professional practice?*

Yes

No

If yes, please explain:

Are you aware of any facts, circumstances or situations which may reasonably give rise to a complaint other than noted above?

Yes

No

If yes, please explain:

Application Uploads

Current Curriculum Vitae or Resume

Max. file size: 100 MB.

Upload Current Vulnerable Sector Police Check

Max. file size: 100 MB.

CVRP accepts softs copies but reserves the right to request a certified copy.

Vulnerable Sector Police Check Expiry

Upload Current Professional Liability Certificate

Max. file size: 100 MB.

CVRP accepts softs copies but reserves the right to request a certified copy.

Liability Certificate Expiry

Upload Government issued ID.

Max. file size: 100 MB.

CVRP accepts softs copies but reserves the right to request a certified copy.

Are you interested in performing peer reviews &/or exam question development?

Yes

No

Registrants can earn 12 CEUs (including ethics) per year.

All information collected during the credential eligibility review form is considered strictly confidential. It will be used solely for the purpose of evaluating the application & will not be disclosed to any unauthorized parties. Access to this information is restricted to individuals directly involved in the review & decision-making process, in compliance with applicable privacy & data protection laws.

Fees

Application Processing & Examination Fee: $290.00 + HST or GST, according to Province/State of Residence, due on submission.

Price:

Tax

$ 0.00 CAD

(Alberta, British Columbia, Manitoba, Northwest Territories, Nunavut, Quebec, Saskatchewan or Yukon)

Tax

$ 0.00 CAD

(Ontario)

Tax

$ 0.00 CAD

(New Brunswick, Newfoundland and Labrador or Prince Edward Island)

Tax

$ 0.00 CAD

(Nova Scotia)

Tax

$ 0.00 CAD

(Foreign)

Total

Credit Card*

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