Retesting Request Form

Retesting Request

This form is to be completed and submitted by candidates who have not passed the certification exam and wish to request approval to retake the exam.
By completing this form, the applicant is formally notifying the Board of their intent to retest and providing any necessary information, fees, and/or documentation required for approval.

Candidates must wait a minimum of 90 days between each exam attempt. Requests to retake the exam will not be approved until the full 90-day period has passed for the date of the previous attempt.

Retesting Limit and Additional Requirements:

Candidates who fail the exam three times may be required to complete additional training, supervision, or other remedial measures as determined by the Board before being approved for a fourth attempt. The Board will review each case individually and provide further instructions if additional requirements are necessary.

Certification Timeframe and Exam Limits:

Candidates have two years from the original date of application submission to complete the certification process and pass the exam. The exam may not be taken more than four times within this two-year period. If a candidate does not pass within this timeframe, they must restart the process by submitting a new application and meeting all current requirements.
Name

First NameLast Name
Address on Photo ID:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Has this address changed since your last exam attempt?
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date of last testing attempt

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Approximate Date of Initial Application

MonthDayYear
2 digit month, 2 digit day, 4 digit yearApproximate Date
Requesting to Retake:
Number of prior attempts:
Were you required by the Board to complete additional training, supervision, or other requirements
IF YES, Upload any documents of additional training or supervision.

Cancelof
How will you be paying for the retesting fee?
Paying via check or money order will add up to 6 weeks of processing time.
Retesting Fees If paying by check or money order do not check these boxes but continue to the next section.
prevnext( X )
AADC Exam Retesting Fee
Payment Information: Candidates may choose to mail a check or money order payable to WVCBAPP at the following address: WVCBAPP 436 12th St. Suite C Dunbar, West Virginia All payments must be received before processing can begin.

$225.00



ADC Retesting Fee
Payment Information: Candidates may choose to mail a check or money order payable to WVCBAPP at the following address: WVCBAPP 436 12th St. Suite C Dunbar, West Virginia All payments must be received before processing can begin.

$225.00



CCJP Exam Retesting Fee
Payment Information: Candidates may choose to mail a check or money order payable to WVCBAPP at the following address: WVCBAPP 436 12th St. Suite C Dunbar, West Virginia All payments must be received before processing can begin.

$225.00



PS I or PSII Exam Retesting Fee
Payment Information: Candidates may choose to mail a check or money order payable to WVCBAPP at the following address: WVCBAPP 436 12th St. Suite C Dunbar, West Virginia All payments must be received before processing can begin.

$225.00



CS Retesting Fee
Payment Information: Candidates may choose to mail a check or money order payable to WVCBAPP at the following address: WVCBAPP 436 12th St. Suite C Dunbar, West Virginia All payments must be received before processing can begin.

$225.00



PRSS SUD or PRSS MH Retesting Fee
Payment Information: Candidates may choose to mail a check or money order payable to WVCBAPP at the following address: WVCBAPP 436 12th St. Suite C Dunbar, West Virginia All payments must be received before processing can begin.

$100.00



Total

$0.00
If paying via PayPal, provide the name of the person or organization associated with the PayPal account.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Retesting Request

Retesting Fees If paying by check or money order do not check these boxes but continue to the next section.