CNLCP® Initial Application

Please check off each item to indicate that you acknowledge that each item is required as a part of this application process.

PLEASE NOTE: There is a Renewal Late Fee of $200.00 within 30 days of expiration.

By checking this box I am indicating that * I have read the Handbook for Candidates and understand I am responsible for knowing its contents. I certify that the information given in this Application is in accordance with Handbook instructions and is accurate, correct, and complete. Information of a candidate's initial certification date, renewal dates, and any CNLCP® suspensions or revocation of CNLCP® will be released by the Universal Life Care Planner Certification Board (ULCPCB™) upon requests to any public entity or agency. Verification is also available via the website tool. By signing this Application, I am providing authorization for release of this information and for the use of aggregate data. I additionally authorize the ULCPCB™ Certification Board to post my name, email address, date of my initial certification and expiration date on the ULCPCB™ website for its online listing of current certified nurse life care planners. Additional personal information will not be released without my approval. * I have completed 2000 hours of paid or “billable” professional experience in a role (e.g., lifecare planning, community-based case management, medical cost projections, Medicare Set-Aside allocations, lifetime nurse care planning, community-based rehabilitation nursing, public health nursing, community-based legal nurse consulting) that utilizes the nursing process in assessing and determining an individual’s long term/lifetime treatment needs and costs across the continuum of care. By checking this box, I certify all of the above statements.