Expedite Request Form
RADT Initial Applicants Only
First Name: ________________________ Last Name: ___________________
Address: _________________________________________________________
City: ______________________________ State: _______ Zip: _________
Employer: ______________________________________________
Is your employer a CCAPP Program Member? Yes ____ No____
Have you completed an RADT Initial Application? Yes ____ No _____
Have you ever been registered before? Yes ____ No ____
By signing this request, you are verifying that you have never been registered with CCAPP and
that you are currently working, or seeking employment, with an organization that is a current
CCAPP Program Member.
I understand that by submitting this request, that my RADT Initial application will be processed
in two (2) working days. Once your application is processed, you will find your verification letter
in your digital wallet.
Signature: _______________________________________ Date: _________________________
Office Use Only
Approved _______ Denied _______ Date: ____________________
(CCAPP Staff member: Please initial, date and upload to professionals Certemy profile)
