Certification Examination Application
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1
2Paper-and-Pencil Certification Examination Application
EXAMS BASED ON 2009, 2012 or 2015 CODE CYCLE
STEP 1: Enter your name, address, and other candidate information.
Exam Candidate Information—PRINT LEGIBLY
.
ALL FIELDS BELOW REQUIRED EXCEPT AS NOTED
Full Legal Name: ___________________________________________________________________________________________________________
Mailing Address: _______________________________________________ City: _________________________ State: ______ ZIP: ______________
(____) ___________________________________________
(____) ___________________________ (____) ____________________________
Primary Telephone Number: _____ Home _____ Work
Secondary Number
Fax Number
(optional)
(optional)
E-mail: ___________________________________________________________________________________________________________________
STEP 2: Select your exam date and site at which you wish to test.
ICC NATIONAL CERTIFICATION EXAMINATION SITES AND CORRESPONDING EXAMINATION DATES
(Sites are subject to change)
□ 001 San Marcos, TX
□ 014 Birmingham, AL
□ 088 Columbia City, IN
□ 5172 Trenton, NJ
□ 072 Conway, SC
□ 021
□ 077 Fairhope, AL
□ 5124 Indianapolis, IN
□ 5205 Bethlehem, PA
□ 1059 Bell Buckle, TN
Sulphur Springs, TX
□ 5174 Bay Area, CA
□ 034 New Orleans, LA
□ 083 Meadville, PA
□ 1029 Sutton, WV
□ 018 Gallatin, TN
□ 022 Lawrenceville, GA
□ 5176 St. Louis, MO
□ 086 Williamsport, PA
□ 039 Memphis, TN
□ 008 Macon, GA
□ 5190 Gulfport, MS
□ 013 Charleston, SC
□ 010 La Porte, TX
□ 087 Crystal Lake, IL
□ 046 Vicksburg, MS
□ 020 Columbia, SC
EXAM DATES
DEADLINE TO REGISTER
EXAM DATES
DEADLINE TO REGISTER
□ March 11, 2017
January 27, 2017
□ September 9, 2017
July 28, 2017
□ June 10, 2017
April 28, 2017
□ December 9, 2017
October 27, 2017
STEP 3: Select the code year on which you wish to test. (Select only one.)
□ 2009 CODE YEAR
□ 2012 CODE YEAR
□ 2015 CODE YEAR
Note: Not all exams are available on all code years . See the National Certification Exam Information Bulletin—P&P for exceptions.
STEP 4: Read the Important Notes section.
Important Notes
Applications may be submitted by U.S. mail, courier, fax, or online at
Applications must be postmarked by the deadline date. Late applications must be pre-approved by the Code Council and submitted with full payment,
including the additional $85.00 late fee.
Examination fees are non-refundable. Exceptions are outlined in the Information Bulletin.
A photo identification, such as a driver’s license, will be required for admittance to the examination.
References needed for taking the exams can be purchased from the Code Council by calling 1-800-786-4452 or at .
A letter will be forwarded to you confirming this registration approximately two weeks prior to the examination administration date.
If you have a physical disability that prohibits you from taking an examination under standard conditions, you may request special arrangements. Your
letter of request must accompany this application, along with a completed special accommodations form. This form may be obtained by telephoning us
at 1-888-422-7233. The request must be submitted and approved by the Code Council 3 months prior to the desired test/administration date.
————— Both pages of this application must be completed to process. —————
Return this completed application in its entirety along with the appropriate fees to:
International Code Council
Certification & Testing Department
900 Montclair Road
Birmingham, Alabama 35213-1206
Fax: 205-599-9884
OFFICE USE ONLY
Candidate ID: _____________________________
Requirements met: _________
Date processed: _______________________
Initials: _________
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