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NCCDP - National Council of Certified Dementia Practitioners - Alzheimer's Training, Dementia Training and Professional Dementia Certifications NCCDP - National Council of Certified Dementia Practitioners - Alzheimer's Training, Dementia Training and Professional Dementia Certifications NCCDP - National Council of Certified Dementia Practitioners - Alzheimer's Training, Dementia Training and Professional Dementia Certifications NCCDP - National Council of Certified Dementia Practitioners - Alzheimer's Training, Dementia Training and Professional Dementia Certifications
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Certified Dementia Practitioner CDP™ Renewal Application

IF YOU ARE WITH GOLDEN LIVING OR YOU WERE PREVIOUSLY WITH GOLDEN LIVING AND YOU ARE A CDCM AND A CDP, PLEASE CLICK HERE.

Please allow 4 to six weeks to process your application
Your certification will be mailed to your home address.

DO NOT FAX IN THE RENEWAL APPLICATION FORM

COMPLETE ALL FIELDS THAT ARE APPLICABLE

International Renewals: Please click here to download form and mail in. You must include a prepaid self addressed envelope for international CDP renewals.

USA CDP RENEWALS: If you wish to mail in the application with a check or credit card click here.

Renewal Fee: $100.00
Late Fee if application is not post marked by the time your CDP expires: additional $10.00

CDP Pin

$12.00

TODAYS' DATE:

   
First Name:
Middle Initial:
Last Name:
Has your name changed in the last 24 months?
Yes
No
If yes, what was your previous name?
Initials (not your title) after your name: Ex. ADC, RN, LCSW, CNA
Are you currently in good standing with your license or certification? Ex. RN, LPN, CNA
Yes
No
Not Applicable, I do not have a license or certification.
List the license or certification numbers:
What state holds your license or certification?
What government agency or certifying body do you have your license or certification with (Example NCTRC)?
Personal Address  
Has your address changed in the last two years?
Yes
No
Current home street address:
City:
State:
Zip Code:
Country:
Home Phone: 
Cell:
Personal Email Address:
Employment Info  
Are you currently employed?  Yes
No
Name of Organization:
Work Address:
City:
State:
Zip Code:
Country:
Work Phone: 
Work Email Address:
Position:
Start Date:
What type of agency:

If Other, Please list   
Please complete the following if NOT EMPLOYED  
If NOT EMPLOYEED, are you currently looking for a job? looking for a job
No, I'm retired
other
If OTHER, please explain.
Please list previous experience if currently not working:
   
I acknowledge that my name will be placed on the NCCDP CDP registry located on the web site. YOUR ADDRESS WILL NOT BE SHOWN ON THE WEB SITE! Your Initial:
   
You are required to complete 10 hours of Continuing Education on any health care related topic within 24 months of your renewal date: You are not required to mail in the certificates with the CDP renewal.


Statement that you have completed the required 10 hours of Continuing Education:

I have successfully completed 10 hours of continuing education (any health care related topic) for the last 24 month period for the two year certification since my last certification renewal. I certify that the information put forth on the CDP Certified Dementia Practitioner renewal / recertification form is true and complete to the best of my knowledge. I further acknowledge that if the information supplied on this form is willfully false, I am subject to disciplinary sanction, including certification suspension/ revocation. 

Please type in your full name in the box below to indicate everything you have stated in the renewal application is true:
Your name:
   
Would you like information on becoming a Certified Alzheimer's and Dementia Trainer through the Train the Trainer class? Yes
No
Would you like information on becoming a CDCM Certified Dementia Care Manager for those overseeing Alzheimer's and Dementia Units in Assisted Living or Nursing Homes? Yes
No
   

Do not send verifying documentation with this form. You are to maintain your certificates of CE or CEU’s for three years following renewal, certificates documenting successful completion of Continuing Education (CE) showing the date and title of the CE program, the number of Continuing Education Units (CEU’s) or contact hours awarded and a certifying signature or other certification of the approved provider. A random audit of CE completion is periodically conducted to verify the preceding statement. The CDP selected for the audit must provide these original documents to the NCCDP by the deadline specified by the NCCDP audit notice.  

 
Code of Ethics
National Council of Certified Dementia Practitioners
Code of Ethics for Certified Dementia Practitioners (CDP®)
  1. The CDP provides services to the health care profession with respect and dignity to the Dementia Client.
  2. The CDP recognizes and respects the Dementia Client individuality.
  3. The CDP participates in ongoing education and stays current with regards to Dementia issues and the National Council of Certified Dementia Practitioners Body of Knowledge.
  4. The CDP maintains competence in his chosen profession.
  5. The CDP will report to the National Council of Certified Dementia Practitioners any acts by a Certified Dementia Practitioner that is illegal or unethical.
  6. The CDP assumes absolute responsibility for your own individual actions.
  7. The CDP will stay current with certifications with the National Council of Certified Dementia Practitioners.
  8. The CDP insures the privacy of the dementia client and applies all HIPPA Regulations.
  9. The CDP works to implement innovative ideas to the health care setting that may help a Dementia Client.
  10. The CDP works to insure that quality of life is provided for the Dementia Clients residing in your health care setting.
  11. The CDP networks with other health care professionals, attends Dementia / Alzheimer’s Seminars, Conventions, Support Groups and Ethics Committees.
  12. The CDP respects the Dementia Clients customs, religious beliefs, and philosophy.
  13. The CDP is truthful and avoids providing false or misleading Information.
  14. The CDP will not use the National Council of Certified Dementia Practitioners on any brochure or advertising without the express permission of this organization and in no way benefit directly or Indirectly at the expense of the National Council of Certified Dementia Practitioners.
  15. The CDP understands that its certification with the National Council of Certified Dementia Practitioners does not in any way confer upon the CDP any type of licensure as a health care provider.
Print your name to indicate that you have read the Code of Ethics:
 

Please allow 4 to 6 weeks to process. Thank you!

 

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