First Name_____________________________________________________________
M.I. __________________________________________________________________
Last Name ____________________________________________________________
Designation(s) _________________________________________________________
Organization or Firm Name ______________________________________________
Mailing/Shipping Address--Line
1 __________________________________________
Mailing/Shipping Address--Line
2 __________________________________________
City State Zip Code ____________________________________________________
Home Phone _________________________________________________________
Work Phone __________________________________________________________
Fax _________________________________________________________________
Preferred E-mail Address ________________________________________________
Chapter Name _________________________________________________________
Member Number _______________________________________________________
Training Date __________________________________________________________
Trained By ____________________________________________________________
Training Date __________________________________________________________
Training Updated By ____________________________________________________
Certified as a PLS in _____________________________________________________
Preferred Testing Site/City _______________________________________________
Secondary Testing Site/City ______________________________________________
QUALIFICATIONS AND TRAINING
NALS members who
have already obtained PP certification are encouraged to administer
the PP, PLS, and ALS exams in their local area. Nonmember certified
PPs may also administer the exams. Administrators may also be
instructors who are employed by educational institutions. Administrators
may assist with PP/PLS/ALS study groups within their chapters
and states.
NOTE: PLSs may give the PLS and ALS exams and likewise ALSs can
give the
ALS exam.
RECOMMENDATIONS
This application requires
two recommendations and can be any two of the following: NALS
board member, region director, state president, or chapter president. The
undersigned hereby recommends _____________________ to
serve as an exam administrator.