SMRPCO Appeals Form

To ensure fairness and consistency, SMRP is reinforcing strict adherence to its established appeals and extension policies. Requests for extensions to the six-month exam eligibility period will only be considered in cases of a documented personal medical issue, family emergency, or exam center issue. Requests for recertification window extensions are limited to documented personal medical issues, family emergencies, unemployment, or financial hardship. All requests must include appropriate supporting documentation and must be submitted within 30 days of the original expiration or termination date to be eligible for review.

Appeals and all related documentation will be dealt with in a strictly confidential manner. By submitting this form, the appellant must agree to hold the filing of the appeal in strict confidence. He/she will not announce or promote in any manner, or use personal or institutional communication vehicles, to announce filing of an appeal.

Full Name

First

Last

the its Name

Phone

Appeals Form

Appeal Category

Please select the certification designation of the appeal

CMRP
CMRT

If this is an extension request, please indicate criteria (documentation required):

Write a brief but detailed statement of the points or issues you believe should be reviewed based on a decision made by the SMRPCO Certification Commission or its representatives related to an individual’s achievement or retention of a certification.

Please provide supportive documentation of appeal. Be specific and definitive.

Supportive Documentation File Upload

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