Application for Florida Competency Examination and Certification as CGC National Certified Guardian
Exam Location:
Exam Date:
Full Name
(as you wish it to appear on your certificate)
Last Four Digits of Credit Card You Are Using to Pay
I have taken a forty hour course approved by the Statewide Public Guardianship Office (Required)
Yes No SPGO Course Nbr: Start Date: End Date:
Are you currently a CGC National Certified Guardian or National Master Guardian?
Yes No
Have you previously taken the Florida competency examination?
Yes No
Business/Firm Name:
Mailing Address:
City: State: Zip:
Work Telephone:
Fax Number:
Home Telephone:
Email Address:
Have you ever been convicted or pled guilty or no contest to a felony?
Yes
No
Have you ever been found civilly liable for an action of fraud, moral turpitude, misrepresentation, material
omission, misappropriation, theft, or conversion? If yes, please submit a letter of explanation, including the case number.
Yes
No
Have you ever been relieved of responsibilities as a guardian or conservator by a court, employer, or client
for actions involving fraud, misrepresentation, material omission, misappropriation, theft, or conversion? If yes, please submit a letter explaining the circumstances.
Yes
No
Are you bonded in accordance with Florida Statute 744.1085? (This is not required until after you pass the examination.)
Yes
No
Have you ever been found liable in a subrogation action by an insurance or bonding agent?
Yes
No
If yes, please explain.
Do you have any special needs requiring CGC attention? Yes No
If yes, please explain.
Please download the Florida Competency Examination Application. Complete and sign National Certified Guardian Declaration and Agreement. Attach a Certificate of Completion and fax to 717-238-9985.
