Crisis Helpline Specialist Re-certification Exam Application

Thank you for your interest in the International Council for Helplines Re-certification Crisis Helpline Specialist Exam.  Please complete the application below.  Once we have received your application and exam fee, we will send you the test instructions and a link to the re-certification exam.  If you have any questions, please email
Please list your name below as you would like it printed on your certificate.
Exam Fee *
Please mail your fee noting your name and Crisis Helpline Specialist Re-certification Exam to:
International Council for Helplines - Finance
6339 Charlotte Pike #551
Nashville, TN  37209
If you would prefer to pay by credit card, check below and a link to the International Council for Helplines PayPal account will be emailed to you.
How would you like to receive your certified helpline specialist certificate? *
Does International Council for Helplines have your permission to publish your name and organization as a certified Crisis Helpline Specialist? *
Please check here if you require any type of accommodation to take the exam.

Test Taking Attestation Statement

By signing below, I attest that I will take the Certified Crisis Helpline Specialist exam in a private location with only myself present and have no one else take the test on my behalf.  I will not use any resources while taking the exam, including books, notes or online information.  Since some of the material contained in the exam is used for future exam administrations, I will refrain from sharing the questions or specific content on the exam to applicants, future applicants or any other persons.  
Electronic Signature (First Name/Last Name) *