I hereby request that the Rhode Island Certification Board grant the credential to me based on the following assurances and documentation:
I subscribe to and commit myself to professional conduct in keeping with the RICB Code of Ethical Conduct;
I hereby certify that the information given herein is true and complete to the best of my knowledge and belief. I also authorize any necessary investigation and the release of information relative to my certification. Falsification of any records or documents in my application will nullify this application and will result in denial or revocation of certification;
I consent to the release of information contained in my application and any other pertinent data submitted to or collected by RICB to officers, members, and staff of the aforementioned Board;
I consent to authorize RICB to gather information from third parties regarding continuing education and employment and understand that such communication shall be treated as confidential;
Allegations of ethical misconduct reported to RICB before, during, or after application for certification is made will be investigated by RICB and could result in the nullification of the application or denial or revocation of certification.