RenewalCertification

PERSONAL INFORMATION:

Last Name:

First Name:

Address:

City:

State:

Zip:

Email:

Daytime Phone:

Church Information:

Church Name:

Pastor's Name:

Church Address:

City:

State:

Zip:

Church Fax

Church Phone:

Church Email:

Electronic Signature Requirements:

By checking this box, I certify that the UPCI Pastor above has approved and will endorse me for the Life In
Focus Education certification.

By checking this box, I certify that all information submitted with this renewal is accurate and complete. I
understand that providing false information may result in revocation of my license and the imposition of
administrative penalties.

PLEASE NOTE: Once you have hit the submit button you will receive a confirmation page. Once you
receive the confirmation you will be redirected to the store to purchase the Renewal Certification for $20.
This is located in the Certification tab in the Life In Focus Store.

ONLINE Renewal APPLICATION

Life in Focus Education
Renewal Application

Renewal fee is $20.

Only the endorsements on-file will renew that are less than 3 months past the expiration date. If over 3 months,
but not more than 6 months past the expiration, the renewal fee is $25.

After December 31, 2011, all renewals that are more than a year old MUST complete the CORE and
Specialized training.