Last Name

First Name

Middle Name

Suffix(Jr, III...)

Title

Mailing Address

City

State

(Select One) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Outside the United States Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

County

(Select One) Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia De Soto Dixie Duval Escambia Flagler Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Miami-Dade Monroe Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam Saint Johns Saint Lucie Santa Rosa Sarasota Seminole Sumter Suwannee Taylor Union Volusia Wakulla Walton Washington * Out of Florida

Country

Primary Phone

Ext.

Email

Web Address

http://

Fax

Business Information: (The following information is only required if different from your individual information.)

Business/Firm Name

Email

Fax

Businnes Location Address

City

State

(Select One) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Outside the United States Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

County

(Select One) Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia De Soto Dixie Duval Escambia Flagler Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Miami-Dade Monroe Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam Saint Johns Saint Lucie Santa Rosa Sarasota Seminole Sumter Suwannee Taylor Union Volusia Wakulla Walton Washington * Out of Florida

Country

Additional Contact Information

Alternate Phone

Ext.

Subject/Trade Area: (Select as many as apply)

Accessibility	Administration	Building – Commercial
Building – Residential	Building – Special Occupancy	Class A Air Conditioning
Class B Air Conditioning	Class C Air Conditioning	Commercial Pool/Spa
Electrical - Commercial	Electrical - Residential	Energy
Existing Building Code	Fire	Fuel/Gas
Mechanical	Other	Plumbing
Pollutant Storage System	Residential Pool/Spa	Roofing
Sheet Metal	Solar

Accreditor Qualifications: (Select one or more qualifications)

Any person with a minimum four year college or graduate degree within the field of study in which the Accreditor will be working.
Degree:
A person who is professionally licensed within the technical field with which they will be accrediting and have a minimum of five years experience in that field.
A substantially qualified authority within their field of relevant expertise.

Supporting Documentation:

Detailed Resume of the Accreditor Resume JDF.pdf

Evaluation Process Flowchart of Processes/Timelines:

Describe how you intend to evaluate courses to ensure 100% compliance with the most current edition of the Florida Building Code and its latest amendments?
JC_Code_Accreditation_Flowchart.pdf

Background Information:

Is applicant approved as a provider by any board within DBPR to provide continuing education? 

Yes

No

If yes, Board (Select One) Asbestos Board of Architecture and Interior Design Board of Landscape Architecture Board of Surveyors and Mappers Building Code Administrators and Inspectors Board Construction Industry Licensing Board Electrical Contractors Licensing Board

DBPR Provider Number

Has any license, registration or permit to practice any regulated profession, occupation, vocation or business been revoked, annulled, suspended, relinquished, surrendered, or withdrawn in Florida or in any other jusrisdiction, or is any such proceeding or investigation now pending? 

Yes

No

If yes, please download and complete Form 0060-1 and then 

Certification Statements:

I agree that payment for accreditation services will be rendered by the Training Provider requesting services directly to the Accreditor offline.

I agree to comply with the Florida Building Commission requirement that this course update take no more than 30 days for courses up to 8 credit hours, and 45 days for courses in excess of 8 credit hours.

I hereby certify that all statements made on this application are true and correct. I agree and understand that any misrepresentations of material facts will result in revocation of this approval.