NAME AND ADDRESS CHANGE FORM for INSTRUCTORS.

NOTICE: Instructors can now update their account record at http://www.nccdp.org/instructor-renewal/login.php.

Instructors can also generate a copy of their certification from within their account page. If your name has changed, simple update your name, click on the MODIFY button and then click on the UPDATE CERTIFICATION button.

Instructors can also update their CDP account by going to http://www.nccdp.org/cdp-renewal/login.php.

If you want NCCDP to update the records and send you an updated certification please continue below.

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If you are a CADDCT® and notifying us of a name change, you will also need to complete a request for lost certificate so we update your name and reissue your certification as a CADDCT® CDP®. You will also need to update the information about yourself/your service in the instructors registry/account.

If you require a new certification there is a $25.00 charge. We recommend you wait for your renewal date instead of requesting a replacement certification. If you cannot wait, please also fill out the replacement form. Follow the link for replacement once you have completed this form.

National Council of Certified Dementia Practitioners®, LLC
1 A Main Street Suite 8
Sparta, NJ 07871-1909
1877.729.5191 Toll Free
contact us form
www.nccdp.org

A new certificate will not be issued. To order a new certification certificate, please click here. 

* - required fields
NCCDP maintains various registries for different certification. Please select where you would like for us to update your contact information.

CDP Registry
CDCM Registry
CFRDT Registry
CFR-DT Registry
Associate Membership
Corporate Membership
Postal mailing/billing List
Email mailing list

CADDCT Registry (please update your contact information yourself by clicking here.)

 

*Name:

*Instructor Number:
Job Title:

Professionals Initials After Your Name EX. RN

Old email address:

* Current or New Email address:

NAME CHANGE

Has your Name changed?
If your name has changed please provide documents that denote the change.
Fax to 973-860-2244 form with supporting documents


If yes, previous name:  
FIRST NAME:
MIDDLE NAME:
LAST NAME:

 

New Name:  
FIRST NAME:
MIDDLE NAME:
LAST NAME:

COMPANY NAME CHANGE

Company Name Currently Listed with NCCDP:

New Company Name to be listed with NCCDP:

HOME ADDRESS CHANGE

Old Address

Street Address:

City:

State:

Zip Code:

Country if other than USA

 

New Address

Street Address:

City:

State:

Zip Code:

Country if other than USA

 

PHONE NUMBER CHANGE

Old Phone Number

New Phone Number

 

COMMENTS: