Certification Test Application

Please allow at least 10 business days for course completion verification.

Once course completion has been verified, you will be mailed a letter, allowing you to test. It is required that you bring this letter with you to the testing center. Note: you must test within one year of your training completion date.

Be sure your mailing address is entered completely and accurately.

The fee to take the exam is $20 and must be paid by credit card to Ivy Tech prior to taking the exam.

Last Name
First Name
Middle Initial
Date of Birth
Address
City
State
Zip Code
Daytime Phone Number
E-mail Address
If you have changed your name or moved within the past 5 years, please enter the information here.

Contact dementia-cert-app@lists.ivytech.edu for assistance.