CFM Certification Application You must have a current AFMA membership and log into your account to receive member pricing.Application for certification or re-certification?*I am a first-time applicantI am applying for re-certificationIs this an appeal?*NoYesApplication Fee AFMA Member - $35 / Non-member - $125Renewal Fee AFMA Member - $25 / Non-member - $80Appeal Fee AFMA Member - $25 / Non-member - $50Personal InformationIf you have an AFMA account, you can log in to have fields pre-filled.Name* First Name Middle Name Last Name Name to appear on certificate if different from above Date of Birth* MM slash DD slash YYYY Place of Birth* Contact InfoWork Phone*Home PhoneCell PhoneFaxEmail* Home Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Code EmploymentEmployer* Job Title* Start Date* Work Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Code Important -- Report address and/or employment changes immediately.Please check all of the following areas of responsibility which you are involved in:* Floodplain Management Hazard Mitigation Building Code Enforcement Building Inspection Health Code On-site Septic Systems Stormwater Management Emergency Management Zoning Enforcement Multi-Objective Management Community Rating System Subdivision Review Planning Review Water & Wastewater Systems Environmental Management Other Specify* Is floodplain management your primary responsibility with your employer?* Yes No Describe your primary responsibility and % of time devoted to FPM :*Please describe your involvement in any special floodplain management or mitigation project which resulted in a reduction in flood hazard within your community (project, date, location):*Additional work experience other than employment listed above:EmployerCity/StateTitleDuration TrainingHave you completed any of the following training courses?FEMA’s "Managing Floodplains Through the NFIP " Training Course* Yes No Any other federal training courses* Yes No Course Name* Any state floodplain management training courses* Yes No Course Name* Any related FPM courses* Yes No Course Name* List all other State or association registrations, licenses or certifications you presently hold:*List professional associations/organizations in which you maintain membership/have held office:*I have read and agree to abide by the* Acknowledgment and Disclaimer Code of Professional Conduct Decertification Policy CommentsThis field is for validation purposes and should be left unchanged.
