CNLCP® Re-Certification Application CNLCP Recertification FormStep 1 of 812%To recertify by exam, please complete the initial application for certification. This application is for Certified Nurse Life Care Planners who wish to recertify by continuing education.When filling out the application, please enter all requested information in the spaces provided or select an option using the menus. If your examination requires supporting documentation, you can upload electronic files in the Supporting Documentation section of the application. Supporting documents must be in PDF or JPG prior to uploading. Be sure to save your application by selecting the Save Application button at the bottom before submitting your application to the Universal Life Care Planner Certification Board (ULCPCB™).Candidate Information Ms. Mrs. Mr. Dr.First Name(Required)Middle Name (optional)Last Name(Required)Email Address: Please enter a valid email address. Please add shirley@daugherty-legalnurse.com to the safe domain list of your email to ensure that emails from ULCPCB™ are received.Email(Required) Enter Email Confirm Email Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland 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Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please be sure to provide us with at least one phone number.Work PhoneHome PhoneCell PhonePlease select your preferred phone for communications(Required) Home Phone Cell Phone Work PhonePlease select your preferred address for mail communications.(Required)Please note: If you chose the “Work/Business” option, please ensure that you have filled the appropriate address information in the box above. Home Work/BusinessRN License Number(Required)License State(Required) AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State When does your license expire?(Required) MM slash DD slash YYYY Current Certification Date(Required) MM slash DD slash YYYY Current Certification Number:(Required)Are you currently a member of AANLCP?(AANLCP membership is not required) No YesAANLCP Membership Number:Are you willing to share your name, address, telephone number and email address with AANLCP?(Required) No YesSelect the organization to which you belong:(Required)Please select all that may apply to you. American Association of Nurse Life Care Planners (AANLCP) American Association of Legal Nurse Consultants American Nurses Association Association of Rehabilitation Nurses Case Management Association of America International Association of Rehabilitation Professionals/International Academy of Life Care Planners National Institute of Case Managers OtherIf you chose “Other” from the above question, please list it here.You are required to provide documentation of your continuing education. Specifically, you must complete 60 CEUs from relevant course content within the five years preceding your initial certification or recertification. A current unrestricted RN license is required throughout this five-year certification period.For information on acceptable course content and alternatives to continuing education, please refer to the recertification guidelines in the CNLCP® Handbook for Candidates.A separate document listing your continuing education must be created. Each entry should include the date and name of the course, contact name and number, address of the CEU provider, number of hours received. A sample template can be found at https://ulcpcb.org/wp-content/uploads/2025/01/Continuing-Education-List-Sample.docx or through a link listed on the website footer.When submitting your application, please upload the following documents: 1. A list of your continuing education as outlined above (first upload) 2. Your current RN license (second upload) 3. Proof of attendance or a certificate of completion for each CEU (second upload) 4. Verification of Work Experience (if applicable-second upload).Please note that proof of attendance and/or copies of certificates should be kept by you for a minimum of five years. Your application and documentation is subject to audit by the certification board.Upload Your List of Continuing Education Here(Required) Drop files here or Select filesAccepted file types: docx, doc, pdf, jpg, Max. file size: 1 GB.Please upload: 1. A copy of your current RN License 2. Proof of attendance or a certificate of completion for each CEU 3. Verification of work experience (if applicable)Upload your RN License, Proof of Attendance/Certificate of Completion, Verification of Work Experience (if applicable) Here(Required) Drop files here or Select filesAccepted file types: docx, doc, jpg, pdf, Max. file size: 1 GB.Candidate Statement of Fact(Required)* I have read the recertification guidelines for Candidates and understand I am responsible for knowing its contents. I certify that the information given in this Application is in accordance with recertification guidelines 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™ 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. By checking this box, I certify all of the above statements. I Acknowledge The Above StatementInput Your Legal Signature(Required)By inputting your signature here, you are acknowledging it as your legal signature.PLEASE NOTE: There is a Renewal Late Fee of $200.00 within 30 days of expiration.CNLCP® Recertification Fees:(Required)Please select the option that applies to you to ensure the correct billing amount is reflected for your payment. Option 1 Recertification by points CEUs AANLCP Association Member 395 Option 2 Recertification by points CEUs non AANLCP member 495 Option 3 Late Recertification AANLCP Association Member 595 Option 4 Late Recertification non member AANLCP 695Option1Recertification by points CEU’s AANLCP Association Member $395 Price: Option2Recertification by points CEU’s non AANLCP Member $495 Price: Option3Late Recertification AANLCP Association Member $595 Price: Option4Late Recertification non member AANLCP $695.00 Price: Please Provide Your AANLCP Membership IDConsent(Required)By checking here, you are agreeing to allow us to post your name, email address, and date of initial certification/expiration on the ULCPCB™ website for its online listing of current certified nurse life care planners. I agree to the listing policy as a part of my re-certification on the ULCPCB website.Credit CardTotal Δ