SMRPCO Certification Surrender Form

Home / Membership / SMRPCO Certification Surrender Form

This form is used to voluntarily surrender the CMRP or CMRT.

SMRPCO certificants agree to notify SMRPCO promptly if they are unable to comply with the recertification requirements, including carrying out the tasks of a CMRP or CMRT and complying with the SMRPCO Code of Ethics. To surrender a certification, the certificant will submit a written request for the voluntary surrender to the SMRPCO Staff, who will forward it to the SMRPCO Certification Committee. Note: This form constitutes the written request.

Date
Month - Day - Year
First Name
Last Name
SMRP ID Number
I would like to voluntarily surrender the following certification:

CMRP
CMRT
Both
Explanation for certification surrender request:

Agreement

By checking this box, I acknowledge that I must: • Discontinue use of all claims to certification that contain any reference to SMRPCO or the CMRP/CMRT upon withdrawal of certification. • Return any certificate issued by SMRPCO to SMRP Headquarters.

For questions or concerns about voluntarily surrendering your certification, please contact SMRP Certification.