application for pmp-13nov11.pdf

8/10/2019 Application For PMP-13Nov11.pdf

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Thank you for your interest in becoming a PMI OPM3 Certified Professional. This certification recognizes

that an individual has met PMIs extensive eligibility requirements in project management, assessing andconsulting, and OPM3practical knowledge, as well as successfully completed the required PMI training

course on the use of the OPM3ProductSuite product. It is also required to gain access to PMIs proprietary

organization assessment and improvement software tools. Achieving the designation ofOPM3 Certified

Professional is the highest recognition of OPM3 expertise in the field.

The application process, the first step to becoming a PMI OPM3Certified Professional, is our opportunity

to learn more about you and the unique experience you bring to the program. Please complete the

application in its entirety and submit via fax to PMI for review. Upon review you will receive notification to

continue with the certification process.

If you have questions that were not answered in theOPM3 Certification Handbook,please do not hesitate

to contact us at [email protected].

Sincerely,

Marvin Hargrove

Organization Product Manager

Questions?

Questions concerning PMI certification

of OPM3Professionals and associated

policies should be directed to:

Project Management Institute

Global Operations Center

Organization Products Manager

14 Campus Blvd

Newtown Square, PA 19073-3299 USA

E-mail: [email protected]

Tel: +1 610 356 4600 ext. 7100

Fax: +1 888 243 3712

14 Campus Blvd | Newtown Square, PA 19073-3299 USA | tel: +1 610 356 4600 | fax: +1 610 356 4647 | PMI.org

OPM3Certified Professional Application
http://www.pmi.org/PDF/OPM3%20Handbook%200209.pdfhttp://www.pmi.org/PDF/OPM3%20Handbook%200209.pdfhttp://www.pmi.org/PDF/OPM3%20Handbook%200209.pdfmailto:opm3.info%40pmi.org?subject=OPM3%20Consultant%20Certification%20Application%20Questionmailto:opm3.info%40pmi.org?subject=OPM3%20Consultant%20Certification%20Application%20Questionhttp://www.pmi.org/PDF/OPM3%20Handbook%200209.pdf


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PMIOPM3Certified Professional Application | Page 1

Contact Information

Last Name: First Name: Middle Initial:

Work

Company Name:

Address: City: State/Province:

Country: Postal Code:

Ofce Phone: Fax: E-mail:

HomeAddress: City: State/Province:

Country: Postal Code:

Home Phone: Mobile Phone: E-mail:

Preferred contact method(s):

E-mail Phone Mail

Preferred Address:

Home Work

Preferred Phone:

Home Mobile

Project Management Experience Requirements

To be eligible, you must meetone

of the following requirements of knowledge and experience categories below.Please reference the OPM3handbook for detailed eligibility requirements.

PMP and/or PgMP Credential HolderPMP / PgMP #:

Bachelors degree or global equivalent AND3 years of project management experience

High school diploma, associate degree or global equivalent AND5 years of project management experience

Project Management Experience

1.Title: Description:

Start Date: End Date:





To complete this form:Save the form to your desktop, type in your information, and submit it by e-mail or print it and send by postal mail or fax.

OPM3Certified Professional Application


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Assessing / Auditing / Consulting Experience Requirements

To be eligible, you must meet oneof the following requirements of knowledge and experience categories below.

Please reference the OPM3handbook for detailed eligibility requirements.

SEI-SCAMPI A Lead Appraiser CertificationCertication Date:

Minimum 500 hours (6 months) of assessing, auditing, or consulting experience over the past three (3) years

(minimum of 50 hours each in _______assessing, _______auditing, and _______consulting)

Assessing Experience







Auditing Experience







Consulting Experience








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OPM3Global Standard Knowledge and Experience Requirements

To be eligible, you must meet oneof the following requirements of knowledge and experience categories below.

Please reference the OPM3handbook for detailed eligibility requirements.

Completion of the OPM3Fundamentals CourseWhere Do Good Projects Come From?

Course Date:

OPM3Self Assessment completed.

OPM3 Global Standard Experience





3.

Title: Description:


Education

1.Institution Name:

Field of Study: Address:

Degree: Year:

2. Institution Name:


Degree: Year:

3.Institution Name:


Degree: Year:


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References

1.Name: Title:

Address: Phone: E-mail:

Relation: How long have you known this person?

2. Name: Title:



3.Name: Title:



Payment

Application Fee US$450

Canadian Tax Information:

Canadian billing addresses: In accordance with Canadian tax law, taxes are collected on all certification-related products. The rateof tax varies depending on the province billing address you use. Tax calculations by province are 15% for Nova Scotia, 13% for NewBrunswick, Newfoundland/Labrador and Ontario; 13.88% for Quebec, 12% for British Columbia and 5% for all remaining provinces. Onlineapplications will automatically calculate tax. Downloaded applications will require insertion of applicable tax. Please note that if youremployer is paying for this purchase and has been granted tax-exempt status by the appropriate Canadian authorities, you will not be ableto use online processing. You will need to mail your application and mail or fax a tax-exempt document meeting the specifications of theCanadian government to the PMI Global Operations Center (fax: +1 610-771-4085).

GST/HST registration: 897944807RT0001; QST registration: 1202723001TQ000

Payment Method (please check one)

Checks, money orders or credit cards are acceptable. Please make checks payable to Project Management Institute.

Checks must be in U.S. currency and drawn on a U.S. bank.

Check(if sent separately from application,photocopy of Contact Information(page 1 of

application) must be included)

Credit Card(Do not send credit card information via email. Electronicsignature is acceptable (//First Name Last Name//)

MasterCard Visa American Express Diners Club Discover

Card Number _______________________ Exp. Date________

Name(as appears on card) ____________________________________________________

Authorized Signature

____________________________________________________

Money Order(if sent separately fromapplication, photocopy of Contact

Information(page 1 of application) must be

included)

Wire Transfer (contact PMI to receive bankdetails)

application for pmp-13nov11.pdf

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