Apply To Be A CPCS


Online CPCS Application 


 The CPCS Application form is listed below in doc and pdf formats.

Only applications with a 4-23-16 revised date at the bottom of the form will be accepted.

Soon we will have an online form to eliminate the paper application process, until then please download the application in either doc or pdf format.

Application Forms
docx PDF

  

Please allow up to 45 days for complete applications to be reviewed.

The CPCS Committee reviews / approves applications once per month. 

 Submit all applications and documentation to:

LPCACPCS@gmail.com

Fax:  (404) 475-2014 (Only for CPCS use)