Retirement Application

This form is for RETIREMENT STATUS only. Upon completion of this form, you will receive a certificate and wallet card that reflects your retired status. This is a permanent change. Return to active status will require retaking the certification examination

The one-time  fee for retirement status is $100.00.

Personal Information
Home Address

The Retirement Status Form is only complete with purchase.  Click "Submit" to make your purchase through our online system.

PLEASE print a copy for your records.