Certified First Responder Dementia Trainer Renewal Application
National Council of Certified Dementia Practitioners

Certified First Responder Dementia Trainer (CFRDT)
Renewal Form


INFORMATION

To complete the renewal online continue below. To print out and send in your renewal application please click here.

General Standards

  • College Graduate. The degree must be from an Accredited College or University.
  • Successfully completed the Train the Trainer Certified First Responders Alzheimer’s / Dementia Course for Instructors by NCCDP approved First Responder Instructor.
  • The certification is for two years. At which time, you will need to renew your certification. To apply for continued certification, you will need to complete at minimum 10 hours of continuing education in the area of health care, Dementia or Alzheimer’s. You will receive a notice in the mail (2 months prior to the deadline) of your upcoming renewal. We offer an online university if you need credits.
  • Must have at minimum three years experience educating First Responders.


INSTRUCTIONS

Please fill out the fields below to create your new account. Fields in BOLD below are required fields. Your account will not be created until these fields are successfully completed.

Following registration you will be directed a payment form.

Fees:

Renewal - $100
Late Fee - $25




General Information  

Middle Initial:

Last Name:

Address:

City:

State-Province:

Country

Zip Code:

Phone Number

Comment/Message

   

   
Employment History  

First Responder Profession

IF Other

Company Name

Your Position

Company Address

Company Phone

Work Email

Certifications or License


 

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 CFRDT 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 certificate last renewal. I certify that the information put forth on the CFRDT 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 sign indicating everything you have stated in the renewal application is true:
Your name
:

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 CFRDT  selected for the audit must provide these original documents to the NCCDP by the deadline specified by the NCCDP audit notice.  

Please allow 6-8 weeks to process. Thank you!

After the REVIEW PAGE you will be directed to the payment page.
We accept Visa, MasterCard, American Express, or Discover.
In order to use a bank Debit Card, the Debit card
must have a Visa, MasterCard, American Express, or Discover Card Logo on the face of the Debit Card.