OPM3 Certified Professional Application

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OPM3 Certified Professional Application Thank you for your interest in becoming a PMI OPM3 Certified Professional. This certification recognizes that an individual has met PMI s extensive eligibility requirements in project management, assessing and consulting, and OPM3 practical knowledge, as well as successfully completed the required PMI training course on the use of the OPM3 ProductSuite product. It is also required to gain access to PMI s proprietary organization assessment and improvement software tools. Achieving the designation of OPM3 Certified Professional is the highest recognition of OPM3 expertise in the field. The application process, the first step to becoming a PMI OPM3 Certified Professional, is our opportunity to learn more about you and the unique experience you bring to the program. Please complete the application in its entirety and submit via fax to PMI for review. Upon review you will receive notification to continue with the certification process. If you have questions that were not answered in the OPM3 Certification Handbook, please do not hesitate to contact us at opminfo@pmi.org. Sincerely, Questions? Marvin Hargrove Organization Product Manager Questions concerning PMI certification of OPM3 Professionals and associated policies should be directed to: Project Management Institute Global Operations Center Organization Products Manager 14 Campus Blvd Newtown Square, PA 19073-3299 USA E-mail: opminfo@pmi.org Tel: +1 610 356 4600 ext. 7100 Fax: +1 888 243 3712 14 Campus Blvd Newtown Square, PA 19073-3299 USA tel: +1 610 356 4600 fax: +1 610 356 4647 PMI.org

OPM3 Certified Professional Application To complete this form: Save the form to your desktop, type in your information, and submit it by e-mail or print it and send by postal mail or fax. Contact Information Last First Middle Initial: Work Company City: State/Province: Country: Postal Code: Office Phone: Fax: E-mail: Home City: State/Province: Country: Postal Code: Home Phone: Mobile Phone: E-mail: Preferred contact method(s): E-mail Phone Mail Preferred Home Work Project Management Experience Requirements Preferred Phone: Home Mobile PMP and/or PgMP Credential Holder PMP / PgMP #: Bachelors degree or global equivalent AND 3 years of project management experience High school diploma, associate degree or global equivalent AND 5 years of project management experience Project Management Experience PMI OPM3 Certified Professional Application Page 1 of 4

Assessing / Auditing / Consulting Experience Requirements SEI-SCAMPI A Lead Appraiser Certification Certification Date: Minimum 500 hours (6 months) of assessing, auditing, or consulting experience over the past three (3) years (minimum of 50 hours each in assessing, auditing, and consulting) Assessing Experience Auditing Experience Consulting Experience PMI OPM3 Certified Professional Application Page 2 of 4

OPM3 Global Standard Knowledge and Experience Requirements Completion of the OPM3 Fundamentals Course Where Do Good Projects Come From? OPM3 Self Assessment completed. Course Date: OPM3 Global Standard Experience Education Institution Institution Institution PMI OPM3 Certified Professional Application Page 3 of 4

References Payment Application Fee US$450 Canadian Tax Information: Canadian billing addresses: In accordance with Canadian tax law, taxes are collected on all certification-related products. The rate of tax varies depending on the province billing address you use. Tax calculations by province are 15% for Nova Scotia, 13% for New Brunswick, Newfoundland/Labrador and Ontario; 188% for Quebec, 12% for British Columbia and 5% for all remaining provinces. Online applications will automatically calculate tax. Downloaded applications will require insertion of applicable tax. Please note that if your employer is paying for this purchase and has been granted tax-exempt status by the appropriate Canadian authorities, you will not be able to use online processing. You will need to mail your application and mail or fax a tax-exempt document meeting the specifications of the Canadian government to the PMI Global Operations Center (fax: +1 610-771-4085). GST/HST registration: 897944807RT0001; QST registration: 1202723001TQ000 Payment Method (please check one) Checks, money orders or credit cards are acceptable. Please make checks payable to Project Management Institute. Checks must be in U.S. currency and drawn on a U.S. bank. Check (if sent separately from application, photocopy of Contact Information (page 1 of application) must be included) Money Order (if sent separately from application, photocopy of Contact Information (page 1 of application) must be included) Wire Transfer (contact PMI to receive bank details) Credit Card (Do not send credit card information via email. Electronic signature is acceptable (//First Name Last Name//) MasterCard Visa American Express Diners Club Discover Card Number Exp. Date Name (as appears on card) Authorized Signature PMI OPM3 Certified Professional Application Page 4 of 4