Certificate Renewal

I hereby apply to renew my NIDE Certificate. I have read the eligibility criteria for certificate renewal. I understand that I am subject to all program requirements for certificate renewal and that certificate renewal depends on successfully completing specified program requirements. If my certificate is renewed, my name will be included in the official NIDE registry. If my certificate is not renewed, I understand that my name will be removed from the official registry. By signing below, I authorize NIDE staff and the Standards of Excellence Council to make whatever inquiries and investigations that they, in their sole discretion, deem necessary to verify my credentials, education preparation, practice, and professional standing, and any other information included in, submitted with, or necessary for review of this application. I expressly acknowledge and agree that information accumulated by NIDE through the certificate renewal process may be used for statistical, research, and evaluation purposes and that NIDE may enter into agreements to release anonymous and aggregate data to schools or external researchers. Otherwise, subject to the mailing list authorization, all information will be kept confidential and shall not be used for any other purposes without my permission. I hereby certify that the information provided on and with this application is true, complete, and correct. I further attest, by my signature, that I will maintain an active certificate throughout the entire certificate renewal period, including all subsequent renewal periods. I understand that any misstatement of material fact submitted on, with, or in furtherance of this application for the certificate shall be sufficient cause for NIDE to: bar me from taking this and future NIDE certificate examinations or submitting a portfolio; invalidate the results of my examination or appraiser’s review of my portfolio; withhold this or other NIDE certificate; revoke this or other NIDE certificates; and take other action against me, including but not limited to notifying licensing authorities, law enforcement agencies, and employers. I further understand that if my certificate record is audited, I will be required to submit documentation to support the information in my application. I further understand that if I fail to timely submit supporting documentation, NIDE can: bar me from taking NIDE certificate examinations or submitting a portfolio; withhold certificate renewal or other certification; revoke this or other NIDE certificates; and take other action against me, including but not limited to notifying licensing authorities, law enforcement agencies, and employers. *