{"id":2278,"date":"2016-06-29T09:55:56","date_gmt":"2016-06-29T16:55:56","guid":{"rendered":"http:\/\/www.breining.edu\/?page_id=2278"},"modified":"2017-10-02T13:02:50","modified_gmt":"2017-10-02T20:02:50","slug":"ccmi-exam-fee-payment","status":"publish","type":"page","link":"https:\/\/www.breining.edu\/index.php\/professional-certification\/certified-case-manager-interventionist-ccmi\/ccmi-exam-fee-payment\/","title":{"rendered":"CCMI Exam Fee Payment"},"content":{"rendered":"<p class=\"p1\"><span class=\"s1\">You may submit a credit card payment for the <strong>Certified Case Manager Interventionist (CCMI) Examination Fee<\/strong>\u00a0using this form.<\/span><\/p>\n<p class=\"p1\">You should only use this form if you have already completed and submitted the\u00a0<strong><a href=\"http:\/\/www.breining.edu\/wp-content\/uploads\/2017\/10\/CCMIAppPacket2017.pdf\" target=\"_blank\" rel=\"noopener\">CCMI Application Packet<\/a><\/strong><\/p>\n<p class=\"p1\">Do not use this form if you included the Exam Fee payment with your initial CCMI Application, and this is your first attempt at the CCMI Exam. You may use this form if this is your second or subsequent attempt to pass the CCMI Exam.<\/p>\n<p class=\"p1\"><span class=\"s1\">You will be automatically sent an email confirming this submission, to the email address that is included in this form, once you have selected the \u201cSubmit\u201d button.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">We will process this payment as soon as possible, typically within one business day.<\/span><\/p>\n<form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-17\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">If you are human, leave this field blank.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-17\" value=\"1775973484\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"17\" id=\"\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 1: Candidate Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField421\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField428\"><div class=\"vfb-form-group\"><label for=\"vfb-field-428\" class=\"vfb-control-label\">Full Name: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-428\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-428\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField432\"><div class=\"vfb-form-group\"><label for=\"vfb-field-432\" class=\"vfb-control-label\">Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-432\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-432\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField433\"><div class=\"vfb-form-group\"><label for=\"vfb-field-433\" class=\"vfb-control-label\">Confirm Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-433\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-433\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-phone\" id=\"vfbField437\"><div class=\"vfb-form-group\"><label for=\"vfb-field-437\" class=\"vfb-control-label\">Primary Phone Number <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-437\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" required=\"required\" data-default-country=\"us\" type=\"tel\" name=\"vfb-field-437\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 2: CCMI Exam Payment Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField418\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField419\"><label for=\"vfb-field-419\" class=\"vfb-control-label\">CCMI Exam Fee <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-419-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-419\" required=\"required\" type=\"checkbox\" name=\"vfb-field-419[0]\" value=\"1\">Non-refundable CCMI Exam fee of $175<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 3: Optional \/ Additional Payment<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField434\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField435\"><div class=\"vfb-form-group\"><label for=\"vfb-field-435\" class=\"vfb-control-label\">If you are going to make a payment in addition to or different than one or more of those included in Section 2, above, please itemize and explain your payment here: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><textarea id=\"vfb-field-435\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" rows=\"10\" name=\"vfb-field-435\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 4: Credit Card and Payment Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField424\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField425\"><div class=\"vfb-form-group\"><label for=\"vfb-field-425\" class=\"vfb-control-label\">You give permission to and authorize Breining Institute to charge the total amount of the items selected in Section 3 and (if applicable) identified in Section 4, to the following credit card:<\/label><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField423\"><label for=\"vfb-field-423\" class=\"vfb-control-label\">Credit Card: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-423-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-423\" value=\"VISA\">VISA<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-423-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-423\" value=\"MasterCard\">MasterCard<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-423-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-423\" value=\"Discover\">Discover<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-number\" id=\"vfbField420\"><div class=\"vfb-form-group\"><label for=\"vfb-field-420\" class=\"vfb-control-label\">Credit Card Number: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-420\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"number\" name=\"vfb-field-420\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField431\"><div class=\"vfb-form-group\"><label for=\"vfb-field-431\" class=\"vfb-control-label\">Full Name on Credit Card: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-431\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-431\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField436\"><div class=\"vfb-form-group\"><label for=\"vfb-field-436\" class=\"vfb-control-label\">Credit Card Expiration Date <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-436\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-436\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField427\"><button id=\"vfb-field-427\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Submit<\/button><\/div><div class=\"vfb-clearfix\"><\/div><\/form>\n","protected":false},"excerpt":{"rendered":"<p>You may submit a credit card payment for the Certified Case Manager Interventionist (CCMI) Examination Fee\u00a0using this form. You should only use this form if you have already completed and submitted the\u00a0CCMI Application Packet Do not use this form if you included the Exam Fee payment with your initial CCMI Application, and this is your [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2201,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2278","page","type-page","status-publish","czr-hentry"],"_links":{"self":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/2278","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/comments?post=2278"}],"version-history":[{"count":6,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/2278\/revisions"}],"predecessor-version":[{"id":5565,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/2278\/revisions\/5565"}],"up":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/2201"}],"wp:attachment":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/media?parent=2278"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}