NGICP Exam

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One Time Credit Card Payment Authorization Form

By completing and submitting this form, you authorize Water Environment Federation to charge your credit card for the amount listed below. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account.

Please complete the information below:

Exam applying for:Champaign, IL
Date of Exam:1/28/2019 - 2/1/2019
First Name*
 
Last Name*
 
Organization
 
Address*
 
City*
 
State*
 
ZIP*
 
Phone 1 (primary)*
 
Phone 2 (alternate)

Email*
 
Date of Birth(MM/DD/YYYY)*
 
Have you taken the NGICP Certification Exam before?*
Yes
No
 
If you have taken the exam before, please provide the location and date (MM/DD/YYYY) in which you previously took the exam.

Education

  1. High School Diploma or GED (or equivalent)
  2. A minimum of 35 contact hours of training in GI construction, inspection, and maintenance of various GI practices (bioretention, blue/green roofs, permeable pavements, rainwater harvesting, dry wells, and stormwater wetlands).
Note: A minimum of a tenth grade reading level is recommended to support candidates in completing the written multiple-choice NGICP exam.

Education*
High School Degree
High School Equivalency(GED)
 
High School Name

High School Location (City, State)

High School Graduation Date (MM/DD/YYYY)
If GED received, please provide the State and Date received
Full legal name at the time you received High School Diploma or Equivalent
Highest level of education.*




 

ADA Training Accommodations

Do you have an ADA Title I disability/impairment for which you may need assistance during the training?


Please send a letter to NGICP@WEF.ORG (from a medical professional authorized to make such assessments) that describes the specific accommodations that will be required.


Applicant Certification*
Yes  

I certify that all information contained in this application, including any attachments forwarded to NGICP@WEF.ORG, is true and correct to the best of my knowledge and belief. I understand that omissions may disqualify me and that knowingly making a false statement may result in the NGICP’s refusal to issue a certificate or a revocation of any certification granted, as well as possible prosecution under appropriate law, which could provide for criminal penalties of a fine, imprisonment or both. I consent to an investigation of my education and training participation and other statements for the purpose of verification of my eligibility for certification. Additionally, I understand that if my application is randomly selected for audit, I may need to provide additional information or sign a release so that my information can be verified. I also understand that if I am successful and I am awarded the NGICP certification, my name, city, state and certification status will be listed on the NGICP website and third party individuals and organizations such as potential employers will be given specific verification of my certification status if it is requested.



Code of Conduct*
I agree to the Code of Conduct  

By agreeing to the Code of Conduct, I agree to adhere to the following Code of Conduct and understand that failure to do so may result in the loss of certification:

  • Act honestly, competently and with integrity;
  • Use my knowledge and skill for the protection of the water environment;
  • Be truthful and accurate in the information I provide to the NGICP;
  • Adhere to all laws and regulations applicable to the profession
  • Promote and encourage a high quality level of work on all green infrastructure projects;
  • Accurately represent my qualifications and credentials;
  • Protect and keep information, including exam content, confidential in order to maintain it as an accurate validation of others’ knowledge in green infrastructure;
  • Strive for continued professional development throughout my career in a way that supports on-going improvement and efficiency of my day-to-day job tasks;
  • Properly use the certificate, stamp and other marks of the NGICP designation, which are the property of WEF, as I am specifically authorized to do so;
  • Uphold and follow all of the policies and procedures outlined in the NGICP Policies and Procedures Manual required in order to become and to remain NGICP certified and in good standing;
  • Represent the NGICP professionally.

I further understand and agree that my signature constitutes a binding acceptance of these pledges and conditions.
I further understand that review within the NGICP Certification Council will be the final determination of any matter arising between NGICP and me.

Please type your FULL NAME and DATE if you agree to the code of conduct:
*  

Payment Information

Authorizes Water Environment Federation to charge the amount listed below.

The cost of this exam is $200.




Amount*: $  
Account Type*:  
Cardholder Name*:  
Card Number*:  
Expiration Date*:  
CVV*:  
The address provided above is the same address for payment
Yes
No
Billing Address*:   Phone*:  
City*:   State*:   ZIP*:  
Email*:  
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. Receipt of payment will be sent to the listed email address, unless otherwise specified.
I certify that my answers are true and complete to the best of my knowledge.  
If you have questions regarding your payment, please contact:

Accounts Receivable

703.684.2427 - Phone
703.684.2428 - Fax
payments@wef.org