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Full Name (First and Last):

Current Position/Title:

Organization:

Preferred Contact Address:

Preferred Contact Phone Number:

I received my Certified Emergency Manager (CEM) or Associate Emergency Manager (AEM) designation from the International Association of Emergency Managers (IAEM) on:

YYYY

My CEM or AEM designation is currently scheduled to expire on:

YYYY

I have emailed my CEM or AEM certificate to UtahCEM@utah.gov

Yes

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Application Fee

Application fees are paid through Eventbrite. A link will be shared with you once your certification has been verified.

Acknowledgement

I understand that certification is subject to the approval of the Utah Emergency Management Professional Certification Review Committee, and if granted, is current until my Certified Emergency Manager (CEM) or Associate Emergency Manager (AEM) designation from the International Association of Emergency Managers (IAEM) expires.

I acknowledge that I will be required to apply for reconsideration of the Utah Certified Emergency Manager designation with each renewal I successfully complete for IAEM’s CEM/AEM. I will provide the necessary documents and supply further information as requested by the committee.

I understand that any false statement or misrepresentation I make in the course of these proceedings may result in the revocation of this application or subsequent certification. I give permission for verification of any information contained in this package.

A copy of your responses will be emailed to the address you provided.

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