NRPA CPSI Exam Application

Exam ApplicationPlease complete this application and return with $ 200 examination fee to:NRPA, CL#500007, PO Box 5007Merrifield, VA 22116-5007Once your application is processed and you receive an email from NRPA, you will then be able to schedule your exam.Your examination fee is non-refundable. You must sit for the exam by the date provided in your email or you willforfeit your examination fee.Initial Exam and Re-test Candidates – You will have 90 days from when your Exam Application is processed toschedule and take the exam. You will be notified of this date when you receive your confirmation email from NRPA.Refer to this email for your exam candidate ID and the testing company (Pearson VUE) contact information to set up thedate, time and location of your examRenewal Candidates – You must submit your application prior to your expiration date. You will have 90 days fromwhen your Exam Application is processed to schedule and take the exam. You will be notified of this date when youreceive your confirmation email from NRPA. Refer to this email for your exam candidate ID and the testing company(Pearson VUE) contact information to set up the date, time and location of your examPlease download the CPSI certification handbook from the NRPA website under the CPSI certification for moreinformation. Please read carefully. This will explain the procedures, proper ways to prepare, and provide exam tips.To be completed by the applicant (please type or print clearly)Why are you applying to take the CPSI exam?  Initial Exam  Re-test  RenewalDo you require special accommodations under the Americans with Disabilities Act?  Yes  No(If yes, please complete the Special Accommodation Request Form at www.nrpa.org/CPSI)NRPA offers a complete list of certified professionals (name, city, state and email) throughour online certification registry. Do you wish to remove your contact information from this list? Yes NoLast Name ______________________________________ First Name _______________________ M.I. ____Mailing Address____________________________________________________________________Suffix ____Apt./Suite # _________City ___________________________________________________ State __________ Zip ___________________Email Address______________________________________________________________________________________________Work Phone ____________________________________________Certification Number (if applicable) ____________________Home Phone ___________________________________Expiration Date ___________________________** If you are registered to take the CPSI course and paper/pencil exam please note that neither the course nor theexam fees will be refundable if you decide to take the computer based exam instead.I have read and understand the CPSI Code of Professional Conduct (SIGNATURE REQUIRED):________________________________________________________________________________________Form of Payment Check ____________________________________________ Credit Card ____________________________________Account #:_____________________________________________________________ Card Expiration Date: ____________________________Demographic SurveySignature: _____________________________________________________________________________________________________________

Certified Playground Safety Inspector (CPSI)Code of Professional Conduct(Please read and sign the application above.)This code sets forth the standards of professional conduct to be observed by CPSIs upon confirmationby the NCB as they act in the capacity of that certification. Certificants shall, in their professionalactivities, sustain and advance the integrity, honor and veracity of their certification by: holding the safety of playground users paramount in all professional services; utilizing the most current standards of care (as delineated by the American Society for Testing andMaterials Standards on Consumer Safety Performance Specification for Public Use, Playgroundsurfacing, and Standard Consumer Safety Performance Specifications for Public Use PlayEquipment for Children 6 months through 23 months, as well as the US Consumer Product SafetyCommissions Public Playground Safety Handbook); maintaining currency and competency in playground safety inspection procedures including use oftesting tools and knowledge of current safety criteria; identifying and documenting all situations which are in non-compliance with the standards of carealong with the citation of the specific reference portion of the criterion document, using a standardplayground safety inspection process; prioritizing all identified non-compliances according to a standard norm of foreseeableconsequences; advising employers or clients of seriously dangerous conditions in the most prompt manner as wellas part of a written report, omitting no adverse findings from the official documentation of thesafety inspection; never conducting a safety audit or inspection without the knowledge and consent of the playgroundowner; never contradicting the findings of another CPSI without first consulting directly with the firstInspector regarding the basis for these findings; never conducting a safety audit of a playground with the intent to discredit an owner ormanufacturer or to promote sale of other equipment or products; and never providing findings of an inspection to anyone other than the playground owner unlessauthorized by the owner to do so.Certified Playground Safety Inspectors who fail to practice these professional standards shall be subjectto disciplinary action outlined in the CPSI Policy and Procedure Manual.March 2011