Senior Professional in Supply Management (SPSM) …

     Senior Professional in Supply Management (SPSM)
            Application for Original Certification

This application is to be completed after satisfying the original certification requirements. To
register for the SPSM Certification Program, visit http://www.NextLevelPurchasing.com/spsm.html


Original Certification Requirements
Applicants for Original SPSM certification must pass the SPSM Exam. In addition, the applicant
must have completed, with an average score of 70% or higher, each of these six online classes
offered by Next Level Purchasing, Inc.:
·   Mastering Purchasing Fundamentals
·   Microsoft Excel For Purchasing Professionals
·   Supply Management Contract Writing
·   Microsoft Project For Purchasing Professionals
·   14 Purchasing Best Practices
·   Savings Strategy Development

Note: Applications must be completed, and all documentation must be submitted, in English.
Once a candidate is certified, he or she must be recertified every four years. Recertification
requires that you earn 32 Continuing Education Hours from Next Level Purchasing, the Institute
for Supply Management and/or its affiliates, and/or the American Production and Inventory
Control Society.


Class/Exam Validity Period
Only exams passed and classes completed within five years of the postmarked date of the application can
be used toward the SPSM certification.




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     Senior Professional in Supply Management (SPSM)
            Application for Original Certification
NOTE: This application is to be used after completing the SPSM Certification Program, including all six
online classes and the SPSM Exam. If you wish to sign up for the SPSM Certification Program, the
appropriate forms to use can be found at http://www.NextLevelPurchasing.com/registration.html


Application must be completed and signed to avoid delays in processing. Please use ink.


APPLICATION FOR:
Check One:       Dr.        Mr.         Mrs.        Ms.        Miss

Clearly print your name exactly how it should appear on the certificate (we will add a comma and the SPSM
credentials, for example, "Charles Dominick, SPSM"). If considering using a middle name/initial, note that
names with 23 or fewer characters fit best:


______________________________________________________________________________________




EMPLOYMENT INFORMATION:
Organization Name ____________________________________
Title __________________________________________________
Address________________________________________________
Address________________________________________________
City __________________________ State____________________ Country ______________________
ZIP ____________________ Telephone______________________________________________
Facsimile ______________________________________________
E-Mail Address __________________________________________


APPLICATION FEES (please check appropriate box):
    Prepaid (as part of SPSM Certification Program package) - USD $0
    Regular (applicable only when individual classes and the SPSM Exam are paid for on a one-by-one
    basis as opposed to part of the all-inclusive SPSM Certification Program) - USD $89


HOME MAILING ADDRESS:
Address________________________________________________
Address________________________________________________

City __________________________ State____________________ Country ______________________

ZIP ____________________ Telephone ___________________________________




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MAIL MY CERTIFICATE & AWARD TO (check one):
(Note: If mailing preference is not specified, your certificate and award will be
mailed to your home address.)
   Employer                Home



PUBLICIZING YOUR ACHIEVEMENT:
You'll get the most career value out of your SPSM Certification if you share the news of your achievement.
One way of sharing the news is having your company newsletter write a story about you earning your SPSM
Certification and the benefit to your organization. If your organization has an internal newsletter, please
provide the contact information for the editor. We'll send your success story to them!

Company newsletter editor's name:
__________________________________________________________

Editor's phone number:
_______________________________________________________________________

Editor's email address:
________________________________________________________________________


PAYMENT METHOD (check one):
     Check enclosed; or


     VISA                     MasterCard                     American Express                         Discover

Name on card:_________________________________________

Card #:_________________________________________________

Expiration date (mm/yy): __ __ / __ __

Card Security Code (3 or 4 digits, usually on back of card): _____________


Address where your credit card statement is sent (you may leave blank if same as the home mailing address
you specified on page 2)

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

Ethics Statement:
I certify that because of the confidential nature of the SPSM examination, I will not copy, retain examination questions, or disclose or
transmit them in any form to any other person. I hereby state that I am working toward my SPSM designation. I understand that taking the
exam for any other purposes is strictly prohibited. I further hereby agree and understand that certification may be denied or revoked, or
SPSM Examination (the "Exam") scores may be invalidated by Next Level Purchasing, Inc. in the event that Next Level Purchasing, Inc.
determines that an individual has (i) falsified or misrepresented information on any certification application or registration forms, or if
information provided in support of obtaining or maintaining certification is found to be in error; (ii) participated in an unauthorized disclosure
of examination questions, information or materials; (iii) plagiarized questions and/or answers on the Exam; (iv) mailed, received, relayed in
any fashion, or used copies of the Exam materials, questions or answers without authorization from Next Level Purchasing, Inc.; (v)
retained the Exam materials after the examination; or (vi) engaged in other nonprofessional behavior or dishonesty with respect to taking,
administering or the preparation of others to take the Exam which results in compromising the integrity of the examination. I further
authorize Next Level Purchasing, Inc. to publish (via e-mail, Web site or print) information about my certification. I hereby certify that the




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information submitted on or with this form is true and accurate to the best of my knowledge, and I agree to be bound by the terms and
conditions set forth herein and by any and all policies and procedures of Next Level Purchasing, Inc. applicable to the SPSM program as
may be amended from time to time.


Signature____________________________________________________________ Date_________________________



The next page indicates the additional material you must
            enclose with your application.




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                         Please submit all material with this application.
                            DO NOT MAIL MATERIAL SEPARATELY.

                You may attach additional sheets for any section if needed.

SPSM Examination
Provide the date you passed the exam and include the score report. You are responsible for providing a
copy of the official score report received after testing.


date passed: ___________


Application Checklist
    SPSM EXAMINATION -- Is a copy of your test score report attached?
    CLASS CERTIFICATE #1 -- Is a copy of your Certificate of Completion for "Mastering Purchasing
    Fundamentals" included?
    CLASS CERTIFICATE #2 -- Is a copy of your Certificate of Completion for "Microsoft Excel For
    Purchasing Professionals" included?
    CLASS CERTIFICATE #3 -- Is a copy of your Certificate of Completion for "Supply Management
    Contract Writing" included?
    CLASS CERTIFICATE #4 -- Is a copy of your Certificate of Completion for "Microsoft Project For
    Purchasing Professionals" included?
    CLASS CERTIFICATE #5 -- Is a copy of your Certificate of Completion for "14 Purchasing Best
    Practices" included?
    CLASS CERTIFICATE #6 -- Is a copy of your Certificate of Completion for "Savings Strategy
    Development" included?
    APPLICATION FEES and SIGNATURE -- Have you included the required application fee and
    additional fees, if any? Did you sign the application?
    DOCUMENT RETENTION -- Did you make copies of all documents submitted? Next Level
    Purchasing, Inc. will not return documents sent with applications.

NOTE: Please send only photocopies of certificates. The original certificates are yours to keep.

Mail the application, documents and all fees to:
      By Postal Mail to:
      Next Level Purchasing, Inc.
      Certification Department
      P.O. Box 1360
      Moon Township, PA 15108
      United States of America

      or

      By courier (e.g., FedEx, UPS, DHL, etc.) to:
      Next Level Purchasing, Inc.
      Certification Department
      1315 Coraopolis Heights Road
      Suite 2002
      Moon Township, PA 15108
      United States of America




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Questions
Questions regarding the program may be directed to Next Level Purchasing, Inc. at:


      Next Level Purchasing, Inc.
      P.O. Box 1360
      Moon Township, PA 15108
      United States of America
      E-Mail: info@nextlevelpurchasing.com

Application Processing
You will receive either (a) a letter of congratulations, award, and SPSM certificate, (b) a letter of denial, or (c)
a request for additional information approximately four weeks after Next Level Purchasing, Inc. receives your
application.

Documentation
Please DO NOT submit copies of your completed application. Next Level Purchasing, Inc. requires your
original application, typed or written in ink.


Appeals Process
Applicants may appeal decisions related to their application. Appeals must be submitted no more than 90
days after the application's date of rejection. Mail written requests with your complete application package
to:
      Next Level Purchasing, Inc.
      P.O. Box 1360
      Moon Township, PA 15108
      United States of America
Next Level Purchasing, Inc. will make a final written decision based on existing policy.


Registering For The SPSM Certification Program
If you would like more information on the SPSM Certification Program, visit
http://www.NextLevelPurchasing.com/spsm.html


If you wish to register for the SPSM Certification Program, please visit
http://www.NextLevelPurchasing.com/registration.html




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