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Application to
Become an IPM Institute Certified IPM Manager
Applications also
available in Word
format.
I. Certified Manager Status
II. Requirements
III. Affidavit
Application Checklist
I. Certified Manager Status
Certified IPM Managers are individuals approved by the IPM Institute
to verify client compliance with requirements of participating labeling
or certification programs using IPM requirements. To verify compliance,
Certified IPM Managers will conduct a site visit; review IPM, pesticide
and other records; and interview the participant. IPM Managers will
prepare a summary report and submit the report to an IPM Institute
Certified Inspector. IPM Institute
Certified Inspectors will conduct site visits
with at least 10% of the IPM Manager’s clients.
A. Classifications: Individuals may apply to become Certified
Managers in Community IPM and/or Agricultural IPM.
B. Requirements: Certified Managers must have a minimum bachelor’s
degree and five years experience within the classification; must
complete an approved training course in verification; and must complete
a minimum of 36 credit hours in approved training every three years.
C. Conflict of Interest: Certified IPM Managers may provide
consulting services, but not pest control product sales, to clients.
D. Certifications accepted in lieu of requirements: Applicants
may submit proof of current certification from the programs specified in
Section II.A. in lieu of documenting education and experience
requirements in this application, with the exception of Section II.E.
Verification Training Course.
E. Benefits: Certified Managers will be granted membership in the
IPM Institute and permission to use the IPM Institute Certified Manager
logo on all business cards and stationary, be listed with full contact
information on the IPM Institute Web site, and receive a certificate and
the IPM Institute quarterly newsletter.
F. Application Fee: A fee of $105 must accompany this
application, and will be refunded if the application is not approved.
G. Renewal: Certified Managers must renew by reapplication after
three years. The application is due by December 31.
H. Appeal of Denial: Applicants who are denied Certified Manager
Status may reapply on resolution of the issue causing denial, or may
appeal in writing to the IPM Board of Directors. Appeals will be
reviewed at the next scheduled Board meeting.
II. Requirements
A. Proof of alternate certification: In lieu of documenting
education, experience and continuing education here, applicant may
submit proof of certification from the following programs:
American Society of Agronomy, Certification Number, Renewal Date
Certified Crop Advisor ____________ ____________
ARCPACS Certified Professional Agronomist ____________ ____________
ARCPACS Certified Professional Crop Scientist ____________
____________
ARCPACS Certified Professional Crop Specialist ____________
____________
ARCPACS Certified Professional Soil Scientist ____________
____________
ARCPACS Certified Professional Soil Specialist ____________
____________
ARCPACS Certified Professional Soil Classifier ____________
____________
ARCPACS Certified Professional Horticulturist ____________
____________
ARCPACS Certified Professional Plant Pathologist ____________
____________
ARCPACS Certified Professional Weed Scientist ____________
____________
Entomological Society of America
Board Certified Entomologist ____________ ____________
National Alliance of Independent Crop Consultants
Certified Professional Crop Consultant ____________ ____________
Certified Professional Crop Consultant - Independent ____________
____________
If you are currently certified, submit proof of certification and
renewal date with this application, and proceed to Section II.E.,
Manager Training Course.
B. Education: A minimum bachelor’s degree from an accredited
institution is required. Please report all degrees granted:
Institution, City, State:
Date of Graduation:
Degree:
Institution, City, State:
Date of Graduation:
Degree:
Institution, City, State:
Date of Graduation:
Degree:
C. Experience: Five years employment in each classification:
1. Current Position:
Employer:
Dates Employed:
Duties:
2. Position:
Employer:
Dates Employed:
Duties:
3. Position:
Employer:
Dates Employed:
Duties:
D. Continuing Education: Applicant must have completed at least
36 hours of approved continuing education within each classification
during the three years prior to the date of application. Approved
courses include those offered by Cooperative Extension and approved for
Pesticide Applicator Training, and those approved for continuing
education by the certification programs listed in II.A. Attach
additional pages as needed.
1. Course Title, City, State:
Instructor:
Date:
2. Course Title, City, State:
Instructor:
Date:
3. Course Title, City, State:
Instructor:
Date:
4. Course Title, City, State:
Instructor:
Date:
5. Course Title, City, State:
Instructor:
Date:
6. Course Title, City, State:
Instructor:
Date:
7. Course Title, City, State:
Instructor:
Date:
8. Course Title, City, State:
Instructor:
Date:
9. Course Title, City, State:
Instructor:
Date:
10. Course Title, City, State:
Instructor:
Date:
11. Course Title, City, State:
Instructor:
Date:
12. Course Title, City, State:
Instructor:
Date:
E. Verification Training Course: Applicants must complete at
least one approved training course on the verification process within
three years of the date of application. For a list and schedule of
approved training courses, see the IPM Institute Web site.
Course Title, City, State:
Instructor:
Date:
Course Title, City, State:
Instructor:
Date:
F. Application Fee:
$105 for three years. Receipt of payment is not a
guarantee of acceptance. Payments with applications not accepted will be
refunded in full.
G. Application Checklist:
1. Read the IPM Verification Program Guidelines and Code of Ethics.
2. Complete an approved training course and continuing education
credits.
3. Complete the application and sign the affidavit.
4. Attach applicable documentation, e.g., proof of certification for
Section II.A., additional pages for continuing education for Section
II.D.
5. Submit the application along with the fee to the IPM Institute of
North America, Inc., 1914 Rowley Ave., Madison WI 53705, telephone
608-232-1528, fax 608-232-1530, email, Web site www.ipminstitute.org
Submit your application fee on-line using
Mastercard or VISA.
III. Certified Manager Affidavit:
Applicant Name:
Company Name:
Mailing Address:
Physical Address (if different):
Phone/Fax:
E-mail address/Web site:
Classification(s) requested:
____ Agricultural IPM ____ Community IPM
Applicant certifies that he/she has read and agrees to abide by the
IPM Verification Program Guidelines, including the Code of Ethics.
Applicant agrees make records supporting both the information provided
on this application and the proper execution of his/her duties as a
Certified Manager available for inspection by the IPM Institute and
participating programs. Applicant certifies that this acceptance of an
application is not a guarantee of current or future employment by the
IPM Institute, participating programs or participants. Certification is
not transferable.
If accepted, applicant agrees to name the IPM Institute an additional
insured on any insurance policy covering the applicants business
activity. Applicant agrees to hold the IPM Institute harmless in the
event this application, reapplication or appeal are denied.
I certify that the information provided is true and complete:
Applicant Signature/Date
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