CEICC Project Sheet

CEICC Project Sheet

Council-certified Environmental Infection Control Consultant

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Instructions		Applicant Info		Verification Contact		Project Summary		Submit Project

Certification Name *
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Stage *
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INSTRUCTIONS

This form is one of FOUR project sheets that must be submitted with your application to fulfill the experience requirement.

Each project sheet must provide contact information for an individual besides yourself (the "verification contact") who is qualified to attest to your involvement in the project. ACAC may contact this individual via phone or email immediately upon submission of this project sheet.

Please note carefully how many years of field experience are required for this certification by reviewing the program description on the acac website. The board will calculate your field experience based on the date of your oldest project sheet.

Need Help? Contact our friendly staff at (888) 808-8381 (M-Th 7 to 4, MST) or via email at info@acac.org.

APPLICANT INFORMATION
Applicant Name
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Required First Name Middle Initial Required Last Name
Last 4 digits of your SSN *
N/A

Non-US candidates, please enter 0000
Applicant Email Address *
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Enter the same email address that you used on your application form.
Primary Phone *
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### ### ####
Applicant Address
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Required
Street Address
Address Line 2 Required City Required

-Select-
State/Region/Province Required
Postal / Zip Code

Required
United States
Country

VERIFICATION CONTACT INFORMATION

Please provide contact information for a person (other than yourself) who can attest to your involvement in the project. ACAC may contact this person via phone or email immediately upon submission of the project sheet.
Verificaton Contact Name
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First Name Last Name
Verification Contact Company *
N/A
Verification Contact Title *
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Verification Contact Email *
N/A

This field must contain an unique, valid email address for your verification contact, including the @ sign, a period (".") in the domain, and no spaces. You may SAVE this form and return to it later if necessary.
Verification Contact Phone *
N/A

### ### ####

PROJECT SUMMARY

Please describe one of FOUR (4) projects that document the field experience required for the designation. Information entered into these fields will be shared with the verification contact.
Project Name *
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Project City/State *
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Facility Type/Size *
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Project Date (Month/Year) *
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Lead/Asbestos Credential
N/A
If this project involved lead or asbestos work, please upload relevant dated credential in PDF or JPG format.

Upload file
Applicant's title/duties on the project *
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Project Summary *
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In 300 words or less, provide 1) a summary of the problem, 2) a first-person explanation of your responsibilities on the project and 3) a brief statement of its outcome. Please do not include the client’s confidential report.
NOTE: ACAC strongly discourages certificants from performing both assessment and remediation services on the same project. ACAC certification boards may not accept applications that document such activities.

DISCLAIMER: In evaluating field experience, ACAC certification boards seek to verify that candidates for certification have been actively engaged in the disciplines served by the certification program – nothing more. The vote to award certification does not imply approval or endorsement of the practices, procedures or techniques described in these project sheets.
Please check the boxes and sign below: *
N/A
Signature (please sign with computer mouse or fingertip) *
N/A

Unsigned project sheets will not be accepted.

E-Signature Field
Clear

SUBMITTING YOUR PROJECT AND NEXT STEPS

When you click Submit below, your project sheet will be sent to ACAC. Please check the boxes below to indicate you understand the next steps in the certification process.
N/A

I understand four (4) project sheets must be submitted to complete my application. * I understand four (4) project sheets must be submitted to complete my application. Required

Upon submission of this project sheet, you will be redirected to the ACAC website to fill out your remaining project sheets. Four (4) project sheet forms must be submitted to complete your application file.
N/A

I understand ACAC may contact the individual listed above to verify details of this project sheet. * I understand ACAC may contact the individual listed above to verify details of this project sheet. Required

ACAC may contact the individual listed above via phone or email asking for verification of your participation in this project. ACAC cannot bring an application file before the certification board without verified field experience.
Need Help? Contact our friendly staff at (888) 808-8381 (M-Th 7 to 4, MST) or via email at info@acac.org.

CEICC Project Sheet

APPLICANT INFORMATION

VERIFICATION CONTACT INFORMATION

PROJECT SUMMARY

SUBMITTING YOUR PROJECT AND NEXT STEPS

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Form Summary

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