NCMA FORT WORTH CHAPTER NCMA CERTIFICATION APPLICATION FEE REFUND

							                       NCMA FORT WORTH CHAPTER
                          NCMA CERTIFICATION
                      APPLICATION FEE REFUND FORM


In order to receive a refund, from the NCMA Fort Worth Chapter, regarding the NCMA
Application Fee required to sit for an NCMA Certification, please fill out the attached form, as
specified below, and certify that the information is current, accurate and complete.

    1. Member must submit this form / certification as an invoice to the NCMA Fort Worth
       Chapter. Timing of submittal does not matter, as long as the exam was taken or CPCM
       was granted after 8/8/06 and in accordance with other guidelines listed below.
    2. Member must first request reimbursement from his / her employer of any fee associated
       with NCMA certification, including the application fee. If the employer rejects the
       request for reimbursement, the NCMA Fort Worth Chapter will reimburse the member,
       only for the Application Fee, in accordance with these guidelines. Member must certify
       that an attempt was made to request reimbursement from their employer, with
       documentation provided herein.
    3. Reimbursement from the NCMA Fort Worth Chapter is only for the $150 application fee
       per certification. No other fees are eligible for reimbursement from the NCMA Fort
       Worth Chapter (e.g. testing fees, study material fees, study session fees, re-certification
       fees, etc…).
    4. NCMA Certification Procedures (reference NCMA National website
       http://www.ncmahq.org/ or NCMA Fort Worth Chapter website http://www.ncmafw.org/
       for additional certification requirements, procedures or information):
           a. Initial Certification (CCCM or CFCM):
                       i. Application Fee - $150
                      ii. Two (2) Exams (General Business and Commercial / FAR)
           b. Subsequent Certification (CCCM or CFCM)
                       i. Application Fee - $150
                      ii. One (1) Exam (General Business exam only taken for initial
                          certification).
           c. CPCM
                       i. Must have already obtained CCCM and CFCM certifications
                      ii. Application Fee - $150
                     iii. Submittal of a Written Essay
    5. Must submit proof of sitting for and passing exam. If no proof exists, then NCMA
       Fort Worth Chapter will reimburse after receipt of this form and confirmation through
       NCMA Headquarters.
           a. For initial CCCM or CFCM, NCMA Fort Worth Chapter will reimburse after
                sitting for and passing the first exam (versus waiting until passing both exams).
           b. For subsequent certification, CCCM or CFCM, reimbursement is after sitting for
                and passing the only exam.
           c. For CPCM, confirmation of acceptance through NCMA Fort Worth Headquarters
                is the only validation method.

Please direct any questions or concerns to the NCMA Fort Worth Chapter Certification Chair.
                      NCMA FORT WORTH CHAPTER
                         NCMA CERTIFICATION
                     APPLICATION FEE REFUND FORM


Name:

Phone #:

Email:

Mailing Address:
City, State Zip:

Date sat / passed exam:


CERTIFICATION:

I,       , certify that I have requested from my employer reimbursement for the
application fee for an NCMA Certification and was subsequently disapproved. If my
employer subsequently reimburses me, in addition to the NCMA Fort Worth Chapter, I
will refund the NCMA Fort Worth Chapter the full amount paid by the NCMA Fort
Worth Chapter.


Signature:

Date:



Please mail form to:
NCMA Fort Worth Chapter
P.O. Box 14171
Arlington, Texas 76094-1171

Please direct any questions or concerns to the NCMA Fort Worth Chapter Certification Chair.