Creative Motion Alliance, Inc.
Application for Level III Professional Certification
in Creative Motion Teaching
(Appendix I)

To apply you may complete the online form below, or download and complete the application form and mail to chair of the Certification Committee.


Date :

NAME
Salutation: Mr. - - Mrs. - - Ms. - - Dr.
First : Last:
Address and Contact Info
Mailing Address - Street Address:
City / Town : State / Province : Zip
Phone:
Other Phone:
E-mail 1:
E-mail 2:


WORKSHOP ATTENDANCE: Please list the dates of workshop attendance during the last five years.
Windswept Music Workshops: (dates)
Mini-Workshops: (include city, dates)
Mini-Workshops: (include city, dates)


Did you receive advance approval from the Certification Committee for your chosen
level III activities? yes no

Have you successfully completed your Level III activities? yes no

Have you completed the Level III written analysis and sent the required
documentation for your Level III activities to the Certification Committee Chair? yes no

Are your CMA dues current? yes no

Will you be paying your certification application fees online? yes no


If you wish to retain a copy of this form for your own records, please print this prior to pressing the Submit button.

This application will be reviewed by the Creative Motion Alliance's Certification Committee.
You will be informed of the committee's decision in a timely manner.