ASME Geometric Dimensioning and Tolerancing Professionals (GDTP) Application for Certification for Technologist and Senior Level

Instructions Review Applicant Information booklet. To apply for Technologist Level certification, complete pages 1 and 2 only. To apply for Senior Level certification, complete pages 1-4. Applicants may apply for only one level of certification at one time. Completed application must be returned to ASME with payment so that it is received at least 30 days prior to the date you wish to take the examination. This form contains fields for the applicant to fill-in. After having entered application information, please print the form and submit to ASME using one of the options outlined on page 2. Examination Level: Mailing address:
Mr. Ms.
(last name) (first name)

Technologist

Senior

Address: Address: Address: City: Country: Home telephone: Fax: Work telephone: email: State: Zip code:

Official List of Certified GDT Professionals:

ASME publishes a list on the ASME web site of those individuals who maintain a valid certification. If the information that you wish to have included on this list is different from your mailing address, provide that information below:

Company: City: State: Country:

The applicant named above makes this application to ASME for GDTP Certification. The applicant agrees to follow the Policy on use of the ASME GDTP Symbols and Authorization. The applicant also agrees to return the Certificate if requested by ASME. Applicants signature
C4.1 (05/11)

Date
Page: 1

Fees: A fee of $375USD* must accompany the completed application. This fee consists of a $50 non-refundable application fee, a $235 examination fee, and a $90 certification fee. The examination fee is refundable if you decide not to take the examination. The certification fee is refundable if you do not take or pass the examination.
( Please note that as of July 1, 2011, the cost of ASME GDTP certification will be $395USD. Applications received after this date will be processed at the new rate: $53 admin. fee, $247 examination fee and $95 certificate fee.)
*

If you have a promotional code, please enter it here: Submit completed application and fees to: Mail: ASME Personnel Certification Processing Department 22 Law Drive Box 2900 Fairfield, NJ 07007-2900 Method of Payment:

Fax: ASME Personnel Certification GDTP Examination 1-212-591-8599

(credit card payments only)

Email: certification@asme.org
(credit card payments only)

Check Visa

Money Order MasterCard

American Express Discover Other

The following information is required for credit card payments: Card number: Exp. date: CSC/CVV2 Codes: (For AMEX, 4 digits on the front of the card and for other cards
this number is on the back and the last 3 digits)

Print name (as it appears on card): Billing address: (exactly as on credit card statement) City: Country: Authorized signature: Applicant name if different than above:
If you are applying for Technologist Level certification, stop here. If you are applying for Senior Level certification, complete pages 3-4.
C4.1 (05/11) Page: 2

State:

Zip: