Replacement CEU Certificate Request Form

EFFECTIVE JULY 1, 2018 --
Replacements for certificates from 2013-2015 will be $10 each; all others from 2016 to the current year will be $5 each. In addition, if the replacement is paid with a check or money order, you have 30 days for us to receive the payment, or the application will be voided.

Submit ONE FORM per certificate being requested.

Example, if you are needing three certificates replaced, you will need to submit three different forms.

Training Information
Name of Training*
Month(s) and Day(s) of Training*
Year of Training*
Personal Informaiton
Name*
First Last
Address*
Street Address City State ZIP Code
Birthday (Include Year)*
Last Four Digits of SSN*
School District*
School*
Cell Phone*
Email Address*
Payment Information
Payment*
- $5 - Check/Money Order
- $5.50 Credit/Debit Card
Payment*
- $10 - Check/Money Order
- $10.50 Credit/Debit Card
FOR PAYMENT BY CHECK, CASH, OR MONEY ORDER:
Please mail the form of payment to the following address:
NMEC
850 Insight Park Avenue, Suite 253C
Post Office Box 1848
University, MS 38677-1848
CEU Replacement Fee*
Price: $10.50
CEU Replacement Fee*
Price: $5.50
Total Due
$0.00

Replacement CEU Certificate Request Form

Submit ONE FORM per certificate being requested.

Training Information

Personal Informaiton

Payment Information

FOR PAYMENT BY CHECK, CASH, OR MONEY ORDER: