Center Application Form

* Name of Organization

* Postal address

P.O Box

* Telephone Number

* Fax Number

Website

* Email

* CR: (Attach file)

* MOL Registration: (Attach file)

Certiport Center ID (If exist)

Register a Certiport CenterRegister a Child Center (I am a Multiple Location Certiport Center)

Parent Center ID#: (if applicable)

Microsoft Affiliations MPN ID #: (Attach file)

Cisco Affiliations Net Academy ID #: (Attach file)