Enrollment Form Enrollment Information First Name Last Name Email Phone (###) ### #### Introduce Yourself (Note Area): Personal/Professional Biography. Spoken Languages * Please indicate which languages you can speak. Please indicate your level of fluency including both written and spoken. Home Address Address 1 Address 2 City State/Province Zip/Postal Code Country Employer Information Please enter your employer Information or if self-employed/ other, let us know here! This helps with understanding where your currently practicing or if you're starting fresh. You do not need to be employed to start your journey to certification. Job Title Date of Hire or Promotion Date of Hire or Promotion to the position of Credit Counsellor within an accredited non-profit credit counselling agency. Credit counsellors must achieve their AFCC within three years of promotion or hire to the position with the agency. This field is required if you work for any accredited non-profit credit counselling agency in Canada. MM DD YYYY Employer Employer Address Address 1 Address 2 City State/Province Zip/Postal Code Country Website http:// Preferred Method of Contact* Phone E-mail Ship Materials To: Please ensure that the shipping location selected, that the corresponding address submitted above is correct and is not a P.O. Box. Materials are delivered by courier and a tracking number will be provided following shipment. Registrants from outside of Canada will be responsible for additional shipping related fees separately. Home Address Employer Address Total: $ 1,899.00 CAD
