{"id":6851,"date":"2018-02-08T09:03:34","date_gmt":"2018-02-08T17:03:34","guid":{"rendered":"http:\/\/www.breining.edu\/?page_id=6851"},"modified":"2018-02-08T09:04:48","modified_gmt":"2018-02-08T17:04:48","slug":"ccmi-exam-scheduling-request","status":"publish","type":"page","link":"https:\/\/www.breining.edu\/index.php\/professional-certification\/certified-case-manager-interventionist-ccmi\/ccmi-exam-scheduling-request\/","title":{"rendered":"CCMI Exam Scheduling Request"},"content":{"rendered":"<h3><span style=\"color: #800000;\">This form should only be used after you have completed taking the CCMI Practice Exam.<\/span><\/h3>\n<form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-29\" 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-29\" value=\"1777672066\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"29\" id=\"\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 1: CCMI Exam Candidate Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField668\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField669\"><div class=\"vfb-form-group\"><label for=\"vfb-field-669\" class=\"vfb-control-label\">Full Name: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-669\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-669\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField670\"><div class=\"vfb-form-group\"><label for=\"vfb-field-670\" class=\"vfb-control-label\">Date of Birth <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-670\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-670\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField672\"><div class=\"vfb-form-group\"><label for=\"vfb-field-672\" class=\"vfb-control-label\">Social Security Number: Last 4 digits only <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">Please only include the last 4 digits (numbers) of your Social Security Number. If you do not have a Social Security Number, please include the last four digits of another government identification card, and identify which government identification you are using.<\/span><input id=\"vfb-field-672\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-672\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField673\"><div class=\"vfb-form-group\"><label for=\"vfb-field-673\" class=\"vfb-control-label\">Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-673\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-673\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField674\"><div class=\"vfb-form-group\"><label for=\"vfb-field-674\" class=\"vfb-control-label\">Confirm Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-674\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-674\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-phone\" id=\"vfbField675\"><div class=\"vfb-form-group\"><label for=\"vfb-field-675\" class=\"vfb-control-label\">Primary Phone Number <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-675\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" required=\"required\" type=\"tel\" name=\"vfb-field-675\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 2. CCMI Exam Request<\/div><span class=\"vfb-help-block\">You should use this form only after you have completed taking the CCMI Practice Exam. You may schedule the full CCMI Exam for any day of the week, and you do not need to specify a time. There must be a minimum of two business days between your completing the CCMI Practice Exam and being able to take the full CCMI Exam, in order for us to verify the CCMI Practice Exam results. And, you must schedule the full CCMI Exam within the 30 days from the date we sent you the email confirming that you are eligible to take the CCMI Exam.<\/span><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField676\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-date\" id=\"vfbField677\"><div class=\"vfb-form-group\"><label for=\"vfb-field-677\" class=\"vfb-control-label\">Please indicate the day that you want to take the full CCMI Exam: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-677\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" data-provide=\"datepicker\" data-date-today-btn=\"linked\" data-date-today-highlight=\"1\" type=\"text\" name=\"vfb-field-677\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 3. CCMI Exam Request Confirmation<\/div><span class=\"vfb-help-block\">Once we receive and process your request, we will send you an email with a link to access and take the full CCMI Exam. If you have not allowed at least two business days for us to process this request, we will schedule you for the next available day.<\/span><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField678\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-captcha\" id=\"vfbField679\"><div class=\"vfb-form-group\"><label for=\"vfb-field-679\" class=\"vfb-control-label\">Captcha <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"g-recaptcha\" data-sitekey=\"6LdWgN0UAAAAAM_hb1SqmzT2DP4J1X289K2epOVA\"><\/div><input type=\"hidden\" name=\"_vfb_recaptcha_enabled\" value=\"1\" id=\"\"><div class=\"vfb-has-error\" id=\"vfb-recaptcha-error\"><span class=\"vfb-help-block\">reCAPTCHA is required.<\/span><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField680\"><button id=\"vfb-field-680\" 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>This form should only be used after you have completed taking the CCMI Practice Exam.<\/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-6851","page","type-page","status-publish","czr-hentry"],"_links":{"self":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/6851","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=6851"}],"version-history":[{"count":2,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/6851\/revisions"}],"predecessor-version":[{"id":6853,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/6851\/revisions\/6853"}],"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=6851"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}