National Council on Family Relations 1201 West River Pkwy, #200 Minneapolis, MN 55454 •888-781-9331
For office use only
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National Council on Family Relations
(For students graduating from a NCFR approved academic program http://ncfr.org/cfle-certification/become-certified/cfle-degree-
programs). Access this form at http://ncfr.org/cfle-certification/become-certified/abbreviated-application-process/abbreviated-
application-form when you are ready to apply to ensure you have the most current information.
I. Name:
Please print or type exactly as you would like your name to appear on your certificate. (Maximum 30 characters).
Preferred Mailing Address:
Telephone: Work: Home: Cell:
E-mail: Alternate E-mail:
II. Collegiate Educational Experience - An original official transcript showing degree completion and successful
completion of the NCFR-approved courses is required. This transcript may be included with this application, mailed from
the school, or sent electronically from the school (to maureenbourgeois@ncfr.org. Include “Maureen Bourgeois” and
NCFR’s address for recipient information). For your convenience, you may apply in your final term before graduation
with an unofficial transcript, with the option of paying your application fee in two installments. After graduation, send
your final official transcript with the balance of the application fee and your application is complete!
Institution Major Degree Level Awarded Year
III. Checklist - Include completed checklist of approved courses provided by university or college or from the NCFR
website at http://ncfr.org/cfle-certification/become-certified/cfle-course-checklists-school.
IV. Fee - Graduates should enclose a non-refundable application fee of $120 (NCFR Members) or $165 (non-members)
for Provisional Certification. Students applying in their final term of enrollment can pay in two installments: $50 initially,
and then $70 (NCFR members) or $115 (non-members) when you send your final official transcript with degree
completion noted. If paying NCFR member rate, include membership number.
NCFR Membership # (found on membership card or mailing label.) Membership application and
fee may be submitted along with the CFLE application. Please pay with separate checks if possible.
$_______________ Check Credit Card VISA MasterCard AMEX Discover Diners Club JCB (Circle one)
Credit Card # Expiration date CVD #
Name, Street Address and Zip Code of card owner:
V. CFLE Code of Ethics - Read and sign the CFLE Code of Ethics and include with your application.
VI. Please print & sign below to verify that the information on this application is accurate to the best of your knowledge.
Name Date
Signature
Certified Family Life Educator (CFLE)
Abbreviated Application - 2015
