Form DBPR CAM 8 Application for Continuing Education Provider Approval or Renewal - Florida

Form DBPR CAM8 or the "Application For Continuing Education Provider Approval Or Renewal" is a form issued by the Florida Department of Business & Professional Regulation.

Download a PDF version of the Form DBPR CAM8 down below or find it on the Florida Department of Business & Professional Regulation Forms website.

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State of Florida
Department of Business and Professional Regulation
Regulatory Council of Community Association Managers
Application for Continuing Education Provider Approval or Renewal
Form # DBPR CAM 8
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Complete all sections of this application.
Continuing Education
 Pay $250 application fee (make check payable to the Department of
Provider Approval/
Renewal
Business and Professional Regulation).
Please mail your completed application, documentation to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0783
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
1) General Requirements
a) To maintain Provider status in good standing, providers must adhere to all provider
requirements outlined in
Rule 61E14-4.002, Florida Administrative
Code; and
Section
455.2178, Florida
Statutes.
b) Provider approval is valid until May 31
of odd numbered years and must be renewed.
st
2) Application Instructions (by section)
a) Section I- Application Types
i.
Continuing Education Provider – Individual : Select this application type if you are an
Individual applying to be a Continuing Education Provider
ii.
Continuing Education Provider – Organization: Select this application type if you are
an Organization applying to be a Continuing Education Provider
b) Section II- Applicant Information
i.
Fill out each section completely.
ii.
In the “Applicant Information” section, applicants must use their name as it appears
on his or her social security card. Do not use any nicknames or initials.
iii. If applying as an Organization or Company, provide the name of the company or
organization that will provide educational services.
iv. A Social Security number is required in order to apply for any individual license within
the Department of Business and Professional Regulation.
v. If you are applying as an Organization or Company you must provide the Federal
Employer Identification Number (FEID) for the business.
vi. If the applicant provides other educational services for another board within the
Department of Business and Professional Regulation, please provide those provider
approval numbers.
vii. Provide your mailing address. This will be used for sending correspondence
regarding your application.
viii. Applicants must provide their business location address.
ix. Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
x. Additional contact information is optional and will be used when the applicant cannot
be reached using their primary contact information.
c) Section III- Affirmation by Written Declaration
i.
Each applicant must sign the affirmation by written declaration.
DBPR CAM 8 CE Provider Approval
2014 December
Incorporated by Rule: 61-35.020
1 of 3
State of Florida
Department of Business and Professional Regulation
Regulatory Council of Community Association Managers
Application for Continuing Education Provider Approval or Renewal
Form # DBPR CAM 8
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Complete all sections of this application.
Continuing Education
 Pay $250 application fee (make check payable to the Department of
Provider Approval/
Renewal
Business and Professional Regulation).
Please mail your completed application, documentation to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0783
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
1) General Requirements
a) To maintain Provider status in good standing, providers must adhere to all provider
requirements outlined in
Rule 61E14-4.002, Florida Administrative
Code; and
Section
455.2178, Florida
Statutes.
b) Provider approval is valid until May 31
of odd numbered years and must be renewed.
st
2) Application Instructions (by section)
a) Section I- Application Types
i.
Continuing Education Provider – Individual : Select this application type if you are an
Individual applying to be a Continuing Education Provider
ii.
Continuing Education Provider – Organization: Select this application type if you are
an Organization applying to be a Continuing Education Provider
b) Section II- Applicant Information
i.
Fill out each section completely.
ii.
In the “Applicant Information” section, applicants must use their name as it appears
on his or her social security card. Do not use any nicknames or initials.
iii. If applying as an Organization or Company, provide the name of the company or
organization that will provide educational services.
iv. A Social Security number is required in order to apply for any individual license within
the Department of Business and Professional Regulation.
v. If you are applying as an Organization or Company you must provide the Federal
Employer Identification Number (FEID) for the business.
vi. If the applicant provides other educational services for another board within the
Department of Business and Professional Regulation, please provide those provider
approval numbers.
vii. Provide your mailing address. This will be used for sending correspondence
regarding your application.
viii. Applicants must provide their business location address.
ix. Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
x. Additional contact information is optional and will be used when the applicant cannot
be reached using their primary contact information.
c) Section III- Affirmation by Written Declaration
i.
Each applicant must sign the affirmation by written declaration.
DBPR CAM 8 CE Provider Approval
2014 December
Incorporated by Rule: 61-35.020
2 of 3
State of Florida
Department of Business and Professional Regulation
Regulatory Council of Community Association Managers
Application for Continuing Education Provider Approval or Renewal
Form # DBPR CAM 8
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
For additional information see the Instructions at the beginning of this application.
Section I – Application Type
CHECK ONE OF THE APPLICATION TYPES
Continuing Education Provider- Individual [3804/1030]
Continuing Education Provider- Organization [3804/1030]
Section II – Applicant Information
APPLICANT INFORMATION (Provider/Owner)
Last/Surname
First
Middle
Suffix
Company/Organization Name
Social Security Number (if applying as an Individual)*
Federal Employer ID Number (if applying as an Organization)
GENERAL IDENTIFICATION
Is Provider approved by any other board within the Department of Business and Professional Regulation
to provide continuing education?
Yes
No
If yes, what is the provider approval number?
MAILING ADDRESS
Company Name
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
BUSINESS LOCATION ADDRESS (IF DIFFERENT THAN MAILING ADDRESS)
Street Address
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
DBPR CAM 8 CE Provider Approval
2014 December
Incorporated by Rule: 61-35.020
3 of 3
Section II – Applicant Information- continued
CONTACT INFORMATION
Last Name (Authorized Representative) First
Middle
Title
Suffix
Primary Phone Number
Primary E-Mail Address
ADDITIONAL CONTACT INFORMATION (OPTIONAL)
Alternate Phone Number
Fax Number
Alternate E-Mail Address
* The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited
by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation
pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and
licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required by § 559.79(1),
Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C)(i), to be
.
used by the Department of Business and Professional Regulation to identify licensees for tax administration purposes
Section III – Affirmation By Written Declaration
AFFIRMATION BY WRITTEN DECLARATION
I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I
understand that my signature on this written declaration has the same legal effect as an oath or
affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts
stated in it are true. I understand that falsification of any material information on this application
may result in criminal penalty or administrative action, including a fine, suspension or revocation
of the license.
Signature:
Date:
Print Name:
DBPR CAM 8 CE Provider Approval
2014 December
Incorporated by Rule: 61-35.020

Download Form DBPR CAM 8 Application for Continuing Education Provider Approval or Renewal - Florida

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