If renewing the Practitioner Certification, please provide the total number of training hours since you received your current certification (we are waiving the required hours for the period of March 2020 to May 2021 due to the pandemic):
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If renewing the Practitioner Certification, please describe how you earned these training hours:
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If renewing the Instructor Certification, please provide the total number of teaching hours since you received your current certification (we are waiving the required hours for the period of March 2020 to May 2021 due to the pandemic):
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If renewing the Instructor Certification, please describe how you earned these teaching hours (i.e. 50 hours at ABC Senior Center, 30 hours at YMCA, etc.)
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Payment for the Renewal
Please press the "Submit" button at the bottom of this form before proceeding to make the payment.