cfm exam application 06 22 2021

APPLICATIONPACKAGE

Forthe

TEXASCERTIFIEDFLOODPLAINMANAGERPROGRAM(CFM®)

AdministeredbytheTexasFloodplain

ManagementAssociation(TFMA)

TEXASFLOODPLAINMANAGEMENTASSOCIATIONCERTIFIEDFLOODPLAINMANAGEREXAMAPPLICATION

DearApplicant:

Attached isanapplicationpacket for registrationasaCertiJiedFloodplainManager through theTexas Floodplain Management Association’s Certi&ied Floodplain Manager Program. Pleasecomplete all necessary forms, the initial TFMA CFM® certiJication will be awarded uponsuccessfulcompletionoffoursteps:

1. Approvalofexamapplicationandfee,2. VeriJicationofapplicantcredentials,3. ProofofcurrentmembershipwithTFMA,4. Passingexamwithagradeof70%orhigher.

In order to facilitate the processing of your application in a timely manner, pleaseremembertoinclude:

_____$150.00ApplicationFee.

_____CompletetheApplicationForm___GeneralInformationSection___ExperienceSection ___EducationSection (HighschooleducationorGEDaminimum)

(Mustdocumenthighestlevelofeducation)

_____Acknowledgment&DisclaimerForm;

_____CodeofEthics

_____SupervisorEmploymentAfJidavitForm

_____CurrentMemberofTexasFloodplainManagementAssociation($50)

_____CFMStampProceduresandPolicy

Report address changes and employment changes immediately on the TFMA website atwww.tfma.org.Thankyouforregisteringtobea CertiJiedFloodplainManager(CFM)andgoodluck!

MailApplicationto:TexasFloodplainManagementAssociation2006 S. Bagdad Road, Ste. 120 Leander, Texas 78641Applicationcanbeemailedto:[email protected]

Updated 02/10/2020 Page of 2 12

http://www.tfma.org

TEXASFLOODPLAINMANAGEMENTASSOCIATION

CERTIFIEDFLOODPLAINMANAGER(CFM®)FEES

ThefollowingfeeshavebeenestablishedbyTFMA:

ApplicationPacket&Exam $150

AnnualMembership $50

AnnualCFM®Renewal $50

LateFee $50(ifnotrenewedbyJanuary15)

RetakeExam $50(mandatory1monthwaittoretake)

RequestforAppeal $100

APPROVALOFFORMSANDFEESMUSTBEPAIDPRIORTOTAKINGTHEEXAM

ApprovalPriortoExam:AllnecessarydocumentationandallfeesmustbesubmittedtotheTFMAExecutiveOfJicetwoweekspriortotakingtheCFM®exam.Ifapplicationandfeesarenotsubmittedandapprovedpriortotheexam,youwillnotbeabletotaketheexamonthescheduleddate.

NoShowforExam:Ifyousubmitallthenecessarydocumentationandfeespriortotheexam,butdonotshowtotaketheexam,feeswillnotberefundedunlesstheTFMAExecutiveOfJiceisnotiJiedinadvance,oryouhavealegitimateexcuseasevaluatedbytheTFMAExecutiveOfJice.

ExamPreparation:TheExamPreparationGuidefortheCerti4iedFloodplainManagerProgramisalistofreferenceswhichmaybeusefulinstudyingandpreparingfortheexam.TheExamPreparationGuideandotherstudymaterialscanbefoundathttps://www.tfma.org/page/Jloodplain-managers-certiJication.



LastNameFirstMiddleMaiden

RequestedDateofExam:_____________________

NametoappearonCertiJicateifdifferentfromabove:

JobTitle

Employer ______________________________________________________________________________________

WorkAddress: (StreetorBoxNumber)

(City)(State)(Zip)

HomeAddress:__________________________________________________________________________________________(StreetorBoxNumber)

_____________________________________________________________________________________________________________(City)(State)(Zip)

PleasesendcorrespondencetomyHomeWorkaddress.

WorkPhone( )_________________HomePhone( )

Cell( )______________________E-mail

AlternateE-Mail:__________________________________________________________________________________

*NOTE:AllInformationprovidediskeptconJidentialbyTFMAandisforrecordkeepingonly.PleasecheckallofthefollowingareasofJloodplainmanagementinwhichyouareinvolved: CoastalManagement CodeEnforcement CommunityRatingSystem EmergencyManagement Engineering EnvironmentalManagement HazardMitigation Insurance Planning&Zoning PublicEducation StormwaterManagementWater&WastewaterSystems

BelowisforofJicialuseonly:Paidonline:_____________Date:________________Amount:$______________________Check#________________DateReceived__________Amt.ofCheck:$________Receipt#_______________DateofExam_________________Score_________________________CertiJicationNo.______________________________________________________________ExamLocation:_______________________________________________________________________________________________


ListotherStateorassociationregistrations,certiJicationsorlicensesheldbyyou:

Have you previously been registered as a CertiJied Floodplain Manager either throughTFMAorASFPMoranotherStateCertiJicationProgram?

YES___NO__IfYES,Pleasegiveregistrationnumberandnameifdifferentfromabove:

CertifyingOrganization/State:

ListallProfessionalAssociationsthatyoumaintainmembershipwith:

HaveyoueverheldanyelectedofJiceinanyoftheabovelistedassociations?YES___NO___IfYES,pleaselistofJiceheld,nameofassociationandtermofofJice:

EDUCATION

Degree(s)Major(s)Year(s)

Checkthehighesteducation:

GED HighSchool Tech&Vocational SomeCollege Bachelor’s Masters PhD

Doyouhavetraininginwaterresources,hydrologyandhydraulics? YES NO

Education


EXPERIENCE

CurrentEmployment

Employername:

JobTitle:

DateofEmployment:From(Month/Year) To:Present

NameofSupervisor:

JobTitle:

TelephoneNumber:( )_______________________ FaxNumber:( )

EmployerType: LocalGovernment StateGovernment RegionalGovernment FederalGovernment Private-Services Private-Products Academia Other:

Have you ever been involved in any special Jloodplain management or mitigation projectwhichresultedinareductioninJloodhazardwithinyourcommunity?YESNO

IfYES,pleasedescribeproject,dateandlocation:

IsFloodplainManagementyourprimaryresponsibilitywithyouremployer? YESNO

IfYES,describeyourprimaryresponsibilityand%oftimedevotedtoFloodplainManagement.


PREVIOUSWORKEXPERIENCE

NOTE: If you have additional work experience to document, please photocopy this pageprior to completing, and attach as many copies of this section as needed to cover yourcompleteworkhistoryasitpertainstoJloodplainmanagement.

Haveyouhadadditionalworkexperienceotherthantheemploymentlistedabove?YESNO

IfYES,please complete the following section. IfNO,please continue to thenext sectionof theapplication.

Employer: Address: YourJobTitle: BrieJlyDescribeJob: DateofEmployment:From(Month/Year)___________________To: Reasonforleaving: ImmediateSupervisor’sName: Supervisor’sTelephone:( )____________________FaxNumber:( ) Employer: Address: YourJobTitle: BrieJlyDescribeJob: DateofEmployment:From(Month/Year)___________________To: Reasonforleaving: ImmediateSupervisor’sName: Supervisor’sTelephone:( )__________________FaxNumber:( )______________________ Employer: Address: YourJobTitle: BrieJlyDescribeJob: DateofEmployment:From(Month/Year)_______________To: Reasonforleaving: ImmediateSupervisor’sName: Supervisor’sTelephone:( )_______________FaxNumber:( )



ACKNOWLEDGMENT&DISCLAIMER

In making application to the CertiJied Floodplain Manager Program for professional certiJication as aJloodplainmanager,Ihavereadandagreetoabidebythe“CertiJiedFloodplainManagerProgram”andtherules and procedures as adopted by the Texas FloodplainManagement Association and its CertiJicationCommittee. Ialsoagreetocompleteallapplicationrequirements,providenecessarydocumentationandtakeallexaminationsasmayberequiredfortheprocessingofmyapplication. UponmyregistrationasaCertiJiedFloodplainManager, Iagree tobeboundby theconditionsofrecertiJicationascontained in theCFMProgram. IfurtherunderstandthatthefeesubmittedwiththisapplicationisnonrefundableandthatthematerialssubmittedforconsiderationbecomethepropertyofTFMAandarenon-returnable.IamsureofthescheduleoffeesandunderstandthatadditionalfeesmustbepaidtokeepmycertiJicationcurrent.Ialso recognize that Imustmeet the continuing education requirements, keepmymembership in TFMAcurrent,andcompleterecertiJicationdocumentationtorenewandkeepmycertiJicationactive.

The certiJication program established by TFMA is approved by the Association of State FloodplainManagers,Inc.(ASFPM)andisaccreditedasaviablestatecertiJicationprogram.IagreetoholdtheTexasFloodplainManagementAssociationand theAssociationofStateFloodplainManagers, Inc., itsmembers,ofJicers,agents,andexaminers free fromanydamageorclaimfordamageorcomplaintbyreasonofanyaction they or any one of them take in connectionwith this application, the attendant examination, thegrades with respect to any examination, the failure of the Association(s) to register me as a CertiJiedFloodplainManager and any other aspect of the CFMProgram. I hereby grant permission to the TexasFloodplainManagementAssociationanditsTraining/CredentialingCommitteetoseekanyinformationorreferences it deems Jit in securingmy credentialspertinent to this application. The samepermission isgrantedtoASFPM.

I further agree that if registered as a CertiJied FloodplainManager, upon the revocation, suspension orcancellationofmycertiJicationbyactionoftheTFMAorASFPM,IshallreturnmyCertiJicate,andanyotheritemsissuedaspartoftheCFMProgramtoTexasFloodplainManagementAssociationortoAssociationofStateFloodplainManagersifsodirected.

Theinformation,whichIhaveprovidedinthisapplication,istruthful. Iunderstandthatprovidingfalse information of any kindmay result in the voiding of this application, andmy failing to beregisteredasaCertiJiedFloodplainManagerortherevocationofmycertiJication. IalsounderstandthatallinformationprovidedaspartofthisapplicationwillremainstrictlyconJidentialunlessauthorizedbymeinwritingtoreleasetheinformationtoarequestingparty.IntheeventthatTFMAdissolvesorisnolongerinvolvedintheCFMProgram,itismyunderstandingthatmyrecordswillbetransferredtoASFPM,Inc. unless the CFM Program is continued by another state organization or state agency and I give mypermissionforthetransferofmyrecordstosuchorganizationoragency.

________________________________________Signature Date


TEXASFLOODPLAINMANAGEMENTASSOCIATION

CERTIFIEDFLOODPLAINMANAGEREXAMAPPLICATION

CODEOFETHICS

AsaCFM®,IagreetofullycomplywiththefollowingtenetsoftheCodeofEthicsinallofmyprofessionalresponsibilities.Iwill:* Protectthehealth,safety,property,andwelfareofthepublicinthepracticeofmyprofession;

* Establishandmaintainahighstandardofintegrityandpractice;

* Practicehonestyandintegrityinallofmyprofessionalrelationshipswiththepublic,peers,andemployer;

* Betruthfulandaccurateinmyprofessionalcommunications;

* Not express a professional opinion in deposition or before a court, administrative agency, orother public forum which may be contrary to generally accepted scientiJic and Jloodplainmanagementprinciple,withoutfullydisclosingthebasisandrationaleforsuchanopinion;

* FosterexcellenceinJloodplainmanagementbystayingabreastofpertinentissues;

* Enhanceindividualperformancebyattentiontocontinuingeducationandtechnology;

* AvoidconJlictsofinterestresultinginpersonalgainoradvantage;

* Be economical in the utilization of the nation’s resources through the effective use of funds,accurateassessmentofJlood-relatedhazards,andtimelydecision-making;

* MaintaintheconJidentialityofprivilegedinformation;

* Promote public awareness and understanding of Jlood-related hazards, Jloodplain resources,andJloodhazardresponse;and

* BededicatedtoservingtheprofessionofJloodplainmanagementandtoimprovingthequalityoflife.

AndIalsoagreetothebestofmyabilityto:

* StandtallandproudasaCertiJiedFloodplainManager,andthroughmydedication,actionsandintegrity,IwillstrivetobeworthyofsuchanhonoreddistinctionandwillpromotethevirtuesofprofessionalcertiJicationinallofmyfuturecontactswithmypeersandmypublic.

__________________________________________________________ ________________________________________Signature Date


CERTIFIEDFLOODPLAINMANAGERPROGRAMDECERTIFICATIONACKNOWLEDGEMENTFORM

AcopyofthissigneddocumentmustbesubmittedwiththeCertiJiedFloodplainManager(CFM®)application.

A.ACFMmaybedecertiJiedforfailuretofulJilltherequirementsspeciJiedinTFMA’sCharterbytherenewaldate.

B.ACFMmaybedecertiJiedforunprofessionalconductifhe/shehas:

(1)Beenconvictedofacrimeoranyfelonydirectlyrelatedtohisorherprofessionalduties;

(2)FalsiJied,intentionallydestroyed,ormodiJiedofJicialrecordsordocumentsrelatingtohisorherprofessional duties, or otherwise knowingly providedmisleading information related to his or herdutiesorJloodplainmanagement;

(3) ReceivedorsolicitedmoneyoranythingofvaluedirectlyorindirectlythatmaybeexpectedtoinJluencehisorheractionsor judgment inamanneroutsideof commonlyacceptablepracticesorvalues;

(4) Usedhis or her position in an illegal, dishonest, or unprofessionalway to inJluence or gain aJinancial or other beneJit, advantage or privilege for his or her beneJit or for beneJit of his or herimmediatefamilyororganizationwithwhichheorsheisassociated;or

(5)ViolatedtheCodeofEthicslistedinTFMA’sCharter.

C.InformationonaCFM’sunprofessionalconductmustbesubmittedtotheTFMAExecutiveOfJiceinwriting.No anonymous submittals will be accepted. If the President of TFMA determines that consideration ofdecertiJicationmaybewarranted,thechargesandallsupportingdocumentationwillbeprovidedtotheCFMbycertiJiedmail.TheCFMshallhave30daysuponreceiptthereoftorespondinwritingtothecharges.

D. If a CFM has not fulJilled the renewal requirements by the renewal date or has not responded to thechargesofunprofessionalconductbythespeciJieddeadline,theCFMwillbedecertiJied,andthereaftermaynotclaimtobea“CertiJiedFloodplainManager”orusetheASFPMRegisteredTrademarkCFM.TheCFMwillbe required to complete anewapplicationpackage,pay the initial application fee, and take theCFMexamagaininordertoregaincertiJication.

E. IftheCFMdoessubmittheappropriatepapersbythedeadline,theproceduresinTFMA’sChartershallbefollowed.

Insigningthisdocument,IacknowledgethatIhavecarefullyreadandfullyunderstandtheforegoingdecertiJicationpolicy and procedure, and I voluntarily accept its application to my continued standing as a CertiJied FloodplainManager.

_______________________________________________________________ ____________________________________________Signature Date


CFMSTAMPPROCEDURESANDPOLICY

UponcompletionandsuccessfullypassingtheCFMExam,aCFMiseligibletoobtainaCFMstamp.It is not a requirement for a CFM to purchase this stamp. TFMA has the following policy forobtainingandmaintainingtheCFMStamp:

CFM®StampUsageGuidelines

I. TheCFMstampshallonlybeusedinthefollowingsituations:a. todocumentaJloodplainactionwithinanindividualareaofexpertisesuchasthe

issuanceordenialofaJloodplaindevelopmentpermit,b. aFEMAElevationCertiJicationSectionG,orc. correspondence,plans,orreportsthatdocumentaJloodplainmanagementaction.

II. ThecertiJicationholder'sstampsignatureandcertiJicationnumbermaybeplacedonthedocumentprovidedtheCFMpreparedordirectedandcontrolledthepreparationofthewrittenmaterials.

III. TheCFMstampmaynotbeusedinanyunprofessional,derogatory,orfrivolousmannerwhichdiscreditstheindividual,ASFPM,oranAccreditedState.

IV. NopersonmayuseorplaceastamponadocumentifthecertiJicationoftheCFMhasexpired,beensuspended,orhasbeenrevoked.

V. TheafJixingorimprintingoftheCFMstamponadocumentshallnotinferorimplythatASFPMortheAccreditedStateapprovesorendorsestheJloodplainmanagementaction.ASFPMandtheAccreditedStatesshallnotbeliableforanydirect,indirect,consequential,special,orotherdamagesresultingfromanystampedJloodplainmanagementaction.

__________________________________________ ___________________________________ Signature Date


CERTIFIEDFLOODPLAINMANAGERPROFESSIONALEMPLOYMENTVERIFICATIONFORM

In lieu of this form, a letter of veriJication incorporating the requested information is acceptable. ThesupervisororagencyheadlistedbelowwillbenotiJiedoftheapplicant’ssuccessfulcompletion.Note:Self-employedpersonsmayuseaprofessionalreferenceotherthanasupervisor.

ApplicantName

Applicant’sTitle EmployedFrom/To

EmployingOrganization

Mr.Ms. SupervisororAgencyHeadName________________________________________________ Title SupervisororAgencyHeadAddress____________________________________________

City/State/Zip_____________________________________SupervisororAgencyHeadPhone/Fax()____________________

Email___________________________________________________________________________________________________________________

I, _________________________________________, (Supervisor) certify that I have supervised/employed the abovelistedapplicant.Iknowofmyownknowledgethatsaidpersonwasemployedasindicatedandthathis/herregularresponsibilitiesincludedJloodplainmanagementandotherrelatedduties.

BrieJlydescribejobresponsibilitiesofapplicant.Pleaseindicateifotherthanfulltime:

_________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

SupervisororAgencyHeadSignature_________________________________________Date


cfm exam application 06 22 2021

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