Retirement Reinstatement Form

Mailing Address
Continuing Education

Important note: To ensure that CCMs maintain their knowledge, skills, and abilities in the field, CCMC requires that 80 hours of continuing education be taken within a 5-year period.  To reinstate, your CEs must have been earned from the date you retired with CCMC through present.

We need a copy(s) of your certificates of completion! Make a scanned copy of your certificates of completion, and upload it here. If you have multiple certificates of completion, please scan them into one PDF or upload a zip file of all the images.
Upload requirements
Please list the name(s) of the courses below.
Please submit a copy of a current license to practice independently
We need a copy of your license/degree! Make a scanned copy of your license/degree, and upload it here.
Upload requirements
Is this license unrestricted?
During the last seven years, have you held a professional license or certification that was revoked, suspended, voluntarily relinquished, or placed on probation or otherwise been disciplined by a professional licensure or certification body?
During the last seven years, have you been reprimanded or discharged by an employer or supervisor for dishonesty in connection with your employment or occupation?
Have you ever been convicted of a felony?
During the last seven years, have you been arrested, accused, or convicted of violating any law or ordinance?
During the last seven years, have you been convicted of violating any law or ordinance dealing with the use, possession, or sale of drugs or alcohol?
During the last seven years, have you been convicted of violating any statute or ordinance dealing with sexual assault, abuse, molestation, indecent solicitation, obscenity, or similar acts of moral turpitude?
During the last seven years, have you received or been offered a grant of immunity in a grand jury proceeding?
Statement of Understanding

I hereby apply for certification as a Certified Case Manager (CCM), a voluntary professional credential sponsored by the Commission for Case Manager Certification (CCMC). I understand that certification depends upon my satisfying all of the criteria for knowledge and experience established by the commission, and that CCMC is the sole judge of my eligibility for certification and that I have no right to question its discretion in granting or denying certification. This includes the submission of all required documents and references.

If, in the sole exercise of its discretion, CCMC extends certification to me, I agree to abide by the Rules of Conduct, as found within the Code of Professional Conduct for Case Managers (Code), which I have read and understand. I also understand that any false, inaccurate, or misleading statements included here will constitute grounds for the suspension or revocation of the CCM designation awarded on the basis of the information contained herein.

As an inducement to the commission and its committees to investigate and reach a determination regarding my character, reputation, and fitness for certification, I hereby release, discharge, and exonerate the commission and its committees, members, agents, and representatives, and any person or entity furnishing documents, records, or other information, from any and all liability of every kind and nature arising out of the furnishing, inspection, or use of such documents, records, or information.

I understand that information submitted as part of the application, certification and certification renewal processes becomes the property of the commission and will not be released to outside parties unless authorized by the applicant/certificant or unless required by law. I also understand that individual score reports are released to me as a candidate and are not released to any institution or employer. Furthermore, I agree that for research and statistical purposes only, data resulting from the certification process may be used in an anonymous/unidentifiable manner.

I further understand that the commission does provide a database listing all certificants on its website, which is updated periodically, for the use of the public, and that the commission also receives and responds to requests for information about the certification status of those holding its credential.

I have read and understand the CCMC Code of Professional Conduct (Principles and Rules of Conduct). To qualify for certification, you must be able to answer yes truthfully.

I understand and agreed to this statement of understanding.

You will be notified by a Certification Navigator within 5-7 business days after your request is submitted.