cpa prep registration form for applicants in the caribbean

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CPA PREP Registration Form for Applicants in the Caribbean

This form is required for applicants to the CPA Prerequisite Education Program (CPA PREP). Please note that applicants must have a completed transcript evaluation in order to be successfully registered. Please save this form to your desktop, complete electronically, and return to [email protected].

(this can be found in your CPA transcript evaluation report)CPA ID Number

Last name (surname/family name)Middle name(s)First name

Street address

Date of birth (MM-DD-YYYY)

PERSONAL INFORMATION

EMPLOMENT INFORMATION

Industry/SectorTitleCompany name

Check if this is your preferred contact information

Gender

Check if this is your preferred contact information

Email address (business)Postal code/Zip code

CountryRegion/StateCity/ParishStreet address

Former legal name (under which degrees have been granted)

City/Parish Region/State

Country Postal code/Zip code Mobile phone (XXX) XXX-XXXX

Email address

HOME CONTACT INFORMATION

Phone (XXX) XXX-XXXX

Business phone (XXX) XXX-XXXX

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MODULE REGISTRATION FEES Please note that all CPA PREP modules are offered via distance at this time. Please refer to the results of your eligibility assessment when selecting from the following courses. Please see the CPA PREP Program Handbook for information regarding prerequisite requirements for each course.

Courses Registration and payment deadline Start and end dates Cost (USD$)

Module 1: Introductory Financial Accounting Open registration Self-paced format $400

Module 2: Introductory Management Accounting Open registration Self-paced format $400

Module 3: Economics Open registration Self-paced format $400

Module 4: Statistics Open registration Self-paced format $400

Module 5: Intermediate and Advanced Financial Accounting Jul. 25 2014 Aug. 4 - Nov. 22 2014 $650

Module 5: Intermediate and Advanced Financial Accounting Jan 2 2015 Jan. 12 - May 2 2015 $650

Module 6: Finance Nov. 14 2014 Nov. 24 2014 - Jan. 10 2015 $350

Module 6: Finance May 8 2015 May 17 - June 20 2015 $350

Module 7: Audit and Assurance Jan. 2 2015 Jan. 12 - Mar. 7 2015 $450

Module 8: Canadian Tax Jul 25, 2014 Jul 28 - Aug 25 2014 $350

Module 8: Canadian Tax Dec 19 2014 Jan. 4 2015 - Feb. 7 2015 $350

Module 8: Canadian Tax Feb. 27 2015 Mar. 9 - Apr. 18 2015 $350

Module 9: Intermediate and Advanced Management Accounting Sep. 5 2014 Sep. 15 - Nov. 29 2014 $550

Module 9: Intermediate and Advanced Management Accounting Apr. 10 2015 Apr. 20 - Jul. 11 2015 $550

Module 10: Strategy and Governance Feb. 6 2015 Feb. 15 - Mar. 21 2015 $350

Module 11: Business Law Register for Aug 24 exam date Self-paced format; requires approximately 20 hours to complete $150

Module 11: Business Law Register for Dec 14 exam date Self-paced format; requires approximately 20 hours to complet $150

Module 12: Information Technology Register for Aug 24 exam date Self-paced format; requires approximately 20 hours to complete $150

Module 12: Information Technology Register for Dec 14 exam date Self-paced format; requires approximately 20 hours to complete $150

TOTAL OF ALL SELECTIONS (calculate manually) USD $

CHALLENGE EXAM FEES Please note that this option is reserved for individuals who have obtained their degree outside of the Caribbean and/or Canada and who have received permission on their Transcript Eligibility Review.

Courses Cost USD$Intermediate and Advanced Financial Accounting $200

Corporate Finance $200

Audit and Assurance $200

Business Law $100

Courses Cost USD$Canadian Tax $200

Intermediate and Advanced Management Accounting $200

Strategy and Governance $200

Information Technology $100

I am paying this fee now for the first time

GENERAL REGISTRATION FEES

Annual Student Registration Fee: USD $150 This fee covers all licensing fees and must be paid in full at the time of registering for your first CPA PREP module. It is then billed annually thereafter.

I have previously paid this fee

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CHARACTER ATTESTATIONS Please respond to each statement listed below using only "yes" or "no". Please use a separate sheet to explain, in sufficient detail, all "yes" responses. Note that incomplete responses may lead to your application being deemed incomplete or the request for registration being denied.

1. Have you ever been convicted of a criminal offence or other similar offence for which a pardon has not been granted or are there any charges pending against you?

2. Have you ever had a professional licence or permit suspended or revoked as a result of a disciplinary matter?

3. Are you, or have you ever been, the subject of an investigation or a disciplinary decision or a form of settlement agreement by an academic institution or a professional body?

4. Have you ever been expelled from a professional society or body (including legacy societies or bodies)?

5. Have you ever made an assignment in bankruptcy, been declared bankrupt or taken the benefit of any statutory provision for insolvency?

6. Have you ever been found guilty of a violation of securities regulatory regulation or tax authority regulation?

DECLARATIONS For each statement listed below, please signify your completion and/or acceptance of the requirement. Note that incomplete declarations may lead to your application being deemed incomplete or the request for registration being denied.

I acknowledge that, if approved for registration, I am subject to the CPA PREP policies and CPA Canada's policies.

I acknowledge and agree that it is my responsibility to provide all required information and documentation acceptable to CPA Canada and to pay the applicable fee for this application.

I acknowledge and agree that CPA Canada may not consider this application to be completed in all respects and may not process, access or accept this application if any of the required information or documentation acceptable to CPA Canada has not been filed or if the applicable fee has not been paid.

I authorize CPA Canada to verify the information provided or to obtain from the organizations concerned any information relevant to this application. I understand that any false or misleading statement contained in my application may be used by CPA Canada in any proceeding respecting the validity of my application or my status as a student.

I understand that as a student or candidate member of CPA Canada, I will be assessed an annual fee. Failure to pay this fee may result in removal from the program.

I understand that I will be required to have access to a PC laptop that meets minimum hardware and software requirements for use in all modules. I understand that Macs are not permitted because of software requirements.

I understand that all materials related to the CPA certification program are the property of CPA Canada.

I understand that module and/or evaluation access or the release of my academic results may be denied if registration item(s) are outstanding.

I hereby declare that all information provided in this application is complete and true. I understand that providing inaccurate or incomplete information on this application is grounds for de-registration and suspension.

Signature Date (MM-DD-YYYY)

CONSENT FOR COMMERCIAL ELECTRONIC MESSAGES: In compliance with Canada's Anti-Spam Legislation (CASL), please indicate if you give CPA Canada your consent to contact you via email for updates and opportunities related to the CPA certification path.

Yes, I provide my consent

Or, click here to indicate your signature electronically.

NoYes

NoYes

NoYes

NoYes

NoYes

NoYes

REFUND POLICY Voluntary module withdrawal requests must be made in writing to [email protected]. Refunds, less a 10% administrative fee, are issued if the written request is received prior to the official module start date. No refunds are issued for requests received on or after the official module start. Please note that the official module start date takes place up to a week before the first class. Students may defer to a later offering of a module. Only one deferral per module may be granted. Deferral requests must be made in writing. PRIVACY STATEMENT The personal information we collect from you is treated in accordance with the CPA Privacy Policy. SUBMISSION After completing and saving this form electronically, please submit to [email protected]. If you are paying by cheque, please see our mailing address below. If you have any questions regarding the application process, please contact us via email at [email protected]. CPA Admissions Department - Caribbean 1559 Brunswick Street, Suite 300 Halifax, Nova Scotia, Canada B3J 2G1

I authorize the processing of the full registration fee that corresponds with my intended program or course as chosen above.

Cheque enclosed (made payable to CMA Nova Scotia)

Card security numberExpiry dateCard number

Name of cardholder (as it appears on the card)

Signature of cardholder

Credit Card (please complete the information below)

VISA MasterCard American Express

PAYMENT INFORMATION Note that we are partnering with CMA Nova Scotia for the financial administration of the CPA PREP Program at this time.

Wire Transfer

Wire Transfer If paying by wire transfer (USD currency only): Please forward to USD Account # 03413-400-367-9 (Society of Management Accountants of Nova Scotia), Royal Bank of Canada, 5855 Spring Garden Road, Halifax, NS Canada B3H 4S2, financial institution # 003, swift code ROYCCAT2, US clearing number ABA # 021000021 (via Chase Bank). **NOTE: Your wire transfer confirmation must be sent to our office via [email protected] to ensure payment is credited to your account

Credit Card

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Please note that credit card payments will be converted from US Dollars to Canadian Dollars prior to processing.

Or, click here to indicate your signature electronically.

Amount to be paid USD $

cpa prep registration form for applicants in the caribbean

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