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Renewal Attestation Form

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Credential renewals are due by April 1st each year. You may renew anytime throughout the calendar year.

Section 1: Graduate Information

Which certificate do you need to renew?*
Check all that apply.
Name*
Email*

Section 2: Renewal Activity

The following are the approved categories for the renewal process. Graduates need to submit a minimum of 3 continuing education hours for each credential that is being renewed (e.g.: 3 hours for OSHA and 3 hours for HIPAA). Hours must be reported in a minimum of 0.5 contact hour increments.

Reminder: All renewal activities must be current within the previous 12 consecutive months and pertain to the credential you are renewing, such as OSHA or HIPAA.

GROWTH CATEGORIES:
  • Educational program. Attendance at a live or live remote course including participation in lectures, workshops or educational sessions.
  • Self-study program. Program approved by an industry-recognized continuing education provider, such as ADA CERP provider or ADG PACE provider. This category includes recorded webinars, audio conferences and online CE programs.
  • Speaking/presenting: Provide a professional presentation at an educational meeting, conference or study club including an in-office training.
  • Authorship: Publish an article or book chapter that is a minium of 750 words in an industry-related publication with at least a readership of 1,000.
Select the category(s) you wish to submit.
Choose all that apply.

CREDENTIAL SPECIFIC CATEGORIES:

Reminder:*

HIPAA Certificates

  • I receive the OCR newsletter. https://www.hhs.gov/hipaa/for-professionals/list-serve/index.html
  • I have watched 2-3 OCR YouTube videos this past year. https://www.youtube.com/@HHS

OSHA Certificates

  • I signed up for the OSHA newsletter. https://www.osha.gov/quicktakes/
  • I watched 2-3 OSHA videos this past year. https://www.osha.gov/video/

Educational Program Activity

Self-Study Program Activity

Speaking/Presenting Activity

Authorship Activity

Section 3: Renewal Attestation

Renewal Attestation*
  • By entering my full name in the space below and transmitting this electronically, I verify that I am the person I represent myself to be, and I affirm the information in this renewal form is true and accurate.
  • My DCI membership is current and in good standing.
  • I attended 3 or more Master Mind meetings this past year.(You have 12months to complete the requirement. It becomes effective for your 2025 renewal.)
  • I fully understand that misrepresenting any information in this renewal process may result in loss of membership and the ability to use the DCI credentials.

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