Canadian Healthcare Engineering Society (CHES)

Canadian Certified Healthcare Facility Manager (CCHFM)

Examination Application

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Please note complete application must be submitted at least 30 days prior to requested testing date

To apply for the CCHFM Examination, complete this CCHFM Examination application and submit a payment with Paypal, or return it with the examination fee to:

    By Mail: CHES National Office, 4 Cataraqui Street, Suite 310, Kingston, ON K7K 1Z7

    By Email: cchfm@ches.org        By Fax: (866) 303-0626

Candidate Information

First Name *

Middle Name

Last Name *

Former Name (if exam was taken previously under a different name)

Name of Facility/Company/Organisation *

Title/Position

Telephone Number *

Email Address *

Confirm Email Address *

I agree *

Membership Status

Please provide your CHES Membership number. *

Examination Fees

Indicate the type of registration you will be paying for $300 - Exam Fee $115 - Self-Assessment Exam Fee $100 - Rewrite Fee $100 - Rescheduling Fee *

Application Status

Check one of the following I am applying as a new candidate
I am applying as a reapplicant., ie:retake the test
*

Examination Type

Check the type of exam administration for which you are applying: Designated assessment center
Special exam administration (For scheduled dates, see www.ches.org)
*

Testing Center Seneca College - Toronto ON Algonquin College - Ottawa ON Georgian College - Barrie ON British Columbia Institute of Technology - Burnaby BC Bow Valley College - Calgary AB Red River College - Winnipeg MB New Brunswick Community College - St. Andrews NB Aurora College - Yellowknife NT Nova Scotia Community College - Yarmouth NS Nunavut Artic College - Cambridge Nay NU Vanier College - St-Laurent QC Intouch Career College - Regina SK Yukon College - Watson Lake YT College of the North Atlantic - Various Locations Mohawk College - Hamilton ON *

Testing Center

Date (choose a date at least 30 days after application date) ... *

Eligibility Requirements

To be eligible for the CCHFM Examination, a candidate must fulfill one of the following education and work experience requirements. By checkingh a box below, a candidate certifies to CHES that he or she satisfies the eligibility requirements.

Check the one that applies

Provide copies of all relevant documents. (CV/resume, Licenses, Degrees, Certificates, Etc.)

 

 

 

 

Special Accomodations

Do you require special disability related accommodations during testing? Yes No *

Demographic Information. The following demographic information is requested.

I certify that I have read all portions of the CCHFM Candidate Handbook and agree to abide by regulations contained therein. I certify that I am eligible to take the CCHFM Examination and the information I have submitted in this application is comkplete and correct to the best of my knowledge and beleif. I understand that, if the information I have submitted is found to be incomplete or inaccurate, my application may be rejected or my CCHFM Examination results may be delayed or voided.

I Agree I Decline *

 

 

Request For Special Examination Accommodations

If you have a disibility please complete this form and the Documentation of Disability-Related Needs so your accommodations for testing can be processed efficiently. The information you provide and any documentation regarding your disability and your need for accommodation in testing will be treated with strict confidentiality.

Special Accommodations

I request special accommodations for the CCHFM examination. Please provide (Check all that apply.):

Special Accommodations Reader Extended testing time (time and a half) Reduced distraction environment Large print test (paper-and-pencil administration only) Circle answers in test booklet (paper-and-pencil administration only) Other special accommodations (Please specify below) *

Other Special Accommodations

Comments

Canadian Healthcare Engineering Society (CHES)

Canadian Certified Healthcare Facility Manager (CCHFM)

Examination Application

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Summary

Candidate Information

First Name

Middle Name

Last Name

Former Name (if exam was taken previously)

Name of Facility/Company/Organisation

Title/Position

Telephone Number

Email Address

CHES Membership Number

Examination Information

Examination Fees

Application Status

Examination Type

Testing Center

Scheduled date

Eligibility Requirements

Demographic Information

How many years of experience do you have in a facilities management; operations and maintenance; clinical engineering; safety and security; planning, design and construction; or environmental management?

How many years have you worked in healthcare facility management?

How many years of experience do you have in management/supervision/administration?

What is the square footage of the facility/facilities you manage?

What is the highest academic level you have attained?

What is your level of responsibility?

Level of Responsibility

Special Accommodations

Other Special Accommodations

Comments

Subtotal

Tax

Total

Payment Type PayPal Pay Later

Pay Later Mail in payment Call in payment

  Submit

Canadian Healthcare Engineering Society (CHES)

Canadian Certified Healthcare Facility Manager (CCHFM)

Examination Application

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Thank you!

Your application has been received. You will be contacted to confirm your eligibility, examination date and location.