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CAOHC

Professional Supervisor of the Audiometric Monitoring Program Recertification Workshop and/or Exam Registration

First Name:*
Last Name:*
Designation:*
(PhD, MD, DO, AuD)
Job Title:

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Indicate any current professional license or registrations, with dates awarded.
Profession State/Territory Date Awarded
Attach copy of your current state licensure or registration:*


Upload your current job description or describe your current duties related to occupational hearing conservation or work related determinations for noise induced hearing loss.


* I verify, to the best of my knowledge, that the information provided in this application is true and accurate. As a condition of CAOHC's consideration of my application to become a CAOHC-approved Professional Supervisor, I agree to the following conditions:

  1. I agree that CAOHC may verify any information provided in this application.

  2. I understand that I must continuously hold licensure as a physician or audiologist for the duration of the certification in order to retain CAOHC certification as a Professional Supervisor of the Audiometric Monitoring Program (CPS/A). CPS/A certification is five years.

Workshop Registration
I wish to register for the May 16, 2019 workshop at Wright Patterson Air Force Base, OH
Military personnel only are welcome to attend this course
I wish to register for the July 28, 2019 workshop at Joint Base McGuire-Dix-Lakehurst, NJ
Military personnel only are welcome to attend this course
I wish to register for the November 17, 2019 workshop at Gaylord National Resort & Convention Center
Recertification Exam Only Registration
I wish to register for the exam only - May 3 - 17, 2019 (ten business days)
I wish to register for the exam only - May 17 - 30, 2019 (ten business days)
I wish to register for the exam only - July 29 - August 9, 2019 (ten business days)
I wish to register for the exam only - November 17 - 27, 2019 (ten business days)
Payment Information  

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(online orders are payable
by credit card only)
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CAOHC
555 E. Wells Street, Suite 1100, Milwaukee, WI 53202-3823
Phone: 414/276-5338    Fax: 414/276-2146      info@caohc.org