Pennsylvania
Recreation and Park Society, Inc.
The following information will be kept in the confidential files of the PRPS Professional Certification Board and will be available only to the Board and the PRPS Appeals Panel. This application will determine eligibility to sit for the Certified Park and Recreation Professional (CPRP) examination during the next scheduled examination period. Approved candidates will be sent the necessary material to apply to sit for the examination.
Please type or print. Thank you. Date
Mr/Mrs/Ms/Miss/Dr (circle one)
Name Title Social Security No.
Employing Agency:
Business Address:
City: State: Zip:
Telephone: Business: Home: Fax:
Email:
Mailing address if different from above:
Address: City: State: Zip:
Telephone:
TYPE OF APPLICATION: Initial
Change of classification from Provisional Park and Recreation Professional (PPRP) to
Certified Park and Recreation Professional (CPRP)
Are you presently a member of the Pennsylvania Recreation
and Park Society: Yes No:
B. A
notarized affidavit of academic school may be submitted for special
consideration in cases where the
school or college attended no
longer exists, or in the case where records have been destroy by fire or
other disasters.
College/University/Other State Degree and Date Completed Major
NRPA/AALR Accredited: Yes No
List your paid experience, in order of most current, in parks, recreation, and leisure services. Volunteer work is not acceptable.
Please complete your application
on the back page.
Revised February 2002
1. Institution/Agency Applicant’s Job Title
Address City State Zip
Telephone Name of Supervisor
Date of Employment (Month/Year) to Full time Part time
Job Description
2. Institution/Agency Applicant’s Job Title
Address City State Zip
Telephone Name of Supervisor
Date of Employment (Month/Year) to Full time Part time
Job Description
3. Institution/Agency Applicant’s Job Title
Address City State Zip
Telephone Name of Supervisor
Date of Employment (Month/Year) to Full time Part time
Job Description
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
* * *
Attachments
Checklist: Official Transcripts Attached Check or Money Order Enclosed
Please list any additional information, which you feel, would assist the PRPS Professional Certification Board in evaluating your application, and attach it to the application.
I CERTIFY THAT ALL
THE INFORMATION GIVEN IN THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY
KNOWLEDGE. I FURTHER UNDERSTAND THAT
FALSE REPRESENTATION RELATIVE TO ANY INFORMATION WILL PROVIDE THE BASIS FOR MY
PERMANENT DISQUALIFICATION FROM PARTICIPATION IN THE ACTIVIES OF THE PROFESSIONAL
CERTIFICATION BOARD. I HEREBY AUTHORIZE
THE PRPS PROFESSIONAL CERTIFICATION BOARD TO MAKE SUCH INQUIRIES AS IT DEEMS
NECESSARY TO VERIFY THE FACTS AS STATED.
DATE SIGNATURE OF APPLICANT SWORN TO AND SUBSCRIBED
BEFORE ME THIS DAY
OF Notary Signature My
Commission expires
This application must be accompanied by a check or money order for the appropriate amount, payable to the:
Pennsylvania Recreation and Park Society, Inc.
Fees: PRPS Member Non-Member
Initial Application $35 $55
Change of Classification $30 $45
Preferred Name on Certificate:
Please submit application to: Pennsylvania Recreation and Park Society, Inc. Telephone: (814) 234-4272
2131 Sandy Drive, State College, PA 16803-2283
OFFICE USE ONLY:
Date Received Amount Paid Check/MO# By
Membership: Yes No Transcripts: Yes No Acknowledged: Yes No