Application for Intermediate Certification

Please ensure that you have met the requirements for Intermediate Certification and have all documents needed before starting this application:

  • Review the Certification Process information page for changes to the process.
  • Current membership on file.
  • Completed Registration for Certification on file.
  • An Endorsement of Supervisor(s) is required to be uploaded with this application.
  • Intermediate certification date (Please note: minimally 30 days’ notice of exam date needs to be given)
  • A registration fee of $100.00 is required.

Please note: All fields marked with an * are required to complete the form.

  • Your Personal Information

  • Date Format: MM slash DD slash YYYY
  • Employer Information

    Complete only if changed from Registration for Certification.
  • Please enter the date you Regsitered for Certification. If you do not know the date please contact the office before proceeding.
  • Education Information

    Complete only if changed from Registration for Certification.
  • Date Format: MM slash DD slash YYYY
  • Candidates Chosen Focus Areas

  • Please indicate the four focus areas in which you are to be examined for Intermediate Certification.
  • Supervision of Exam

  • It is the responsibility of the exam candidate to arrange for the exam to be supervised by a supervisor or Agency Administrator. Please indicate who will be supervising your intermediate exam.
  • Please give minimally 30 days' notice of exam date:
  • Date Format: MM slash DD slash YYYY
  • Your exam supervisor will receive instructions regarding the supervision and return of the exam.
  • Candidates Acknowledgement

    I attest that the information provided is true and complete to the best of my knowledge. I understand that misrepresentation could result in decertification by The Child and Youth Care Association of Alberta.
  • Drop files here or
    Accepted file types: jpg, jpeg, png, pdf, doc, docx, odt.
    Please upload a signed copy(ies) of the "Endorsement of Supervisor for Certification" document.
  • Price: $ 100.00 CAD

Personal Information Protection

The information requested in this form is collected under the Personal Information Protection Act for Child and Youth Care Association of Alberta’s internal use only.  No information contained in this form will be disclosed to any other individual, group, or agency as per the Confidentiality Policy of the Child and Youth Care Association of Alberta.  Questions concerning this collection should be directed to info@cycaa.com.