TI:ME Certification Application Level 2
    1. Register Your TI:ME Course Level Two Completion for Certification

      TI:ME Course Completion of any three Level 2B TI:ME Courses plus the completion of TI:ME Level 2C entitles you to register your successful completion of the studies with TI:ME, and get an immediate emailed receipt and acknowledgment of your certification registration plus a copy of the data you've submitted.

      In addition, registration with our TI:ME Certification Registry allows you to request a personalized, official TI:ME Level Two Certification certificate with your name and course certification on it, delivered via email in PDF form, suitable for color printing and framing.
      Certification Registration is available to qualified TI:ME members who complete this form and submit it with the Certification Registration Fee of $35.00. At this time, payment is accept via PayPal, whether you are using a credit card, or your PayPal account for payment. Certification Registration is available exclusively online beginning Jan, 2012.

      If you have questions, please email TI:ME's Executive Director before submitting this form and being taken to PayPal to complete the submission to the Certification Registry System.
    2. First Name * Required Information
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      Please enter your first name as you want it to appear on your certificate
    3. Last Name * Required Information
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      Please enter your last name as you want it to appear on your certificate
    4. Address 1 * Required Information
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      Please enter your address
    5. Address 2
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      Address 2 is for entering a suite, apartment or other similar information
    6. City * Required Information
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      Please enter the city of your address
    7. State * Required Information
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      Please enter the name of your state
    8. Zip Code * Required Information
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      Enter your Zip Code
    9. Country * Required Information
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      Please enter the name of the country you in which you reside
    10. Email Address * Required Information
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      Please enter your preferred email address
    11. Phone * Required Information
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      Please enter your primary contact phone number
    12. School Name or Professional Affiliation * Required Information
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      Please enter your School Name or Professional Affiliation
    13. I have successfully completed Levels One A and B and have been Certified by TI:ME. * Required Information
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    14. I affirm that I have successfully completed at least one of the following Level 2A and at least one of the following Level 2B Courses * Required Information







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      Please check all that apply and provide details below on locations, dates of completion and instructor names.
    15. I completed my course study for the 1st required TI:ME Level 2 Course at this Institution or School: * Required Information
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    16. My first TI:ME Level Two Course was: * Required Information







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      Please check one then provide the location, instructor's name and date below.
    17. For the first TI:ME 2A or 2B completed requirement my Instructor's First Name is: * Required Information
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      Please provide your TI:ME Level 2A/2B instructor's first name for the first of three courses required from this level.
    18. For the first TI:ME 2A or 2B completed requirement my TI:ME Instructor's Last Name is: * Required Information
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      Please provide your instructor's last name
    19. On this date, I completed the course study for the first TI:ME Level 2A or 2B course. * Required Information
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      Please choose the data of completion
    20. My second TI:ME Level Two Course was: * Required Information







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      Please check one then provide the location, instructor's name and date below.
    21. I completed my course study for the 2nd required TI:ME Level 2 Course at this Institution or School: * Required Information
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    22. For the second TI:ME 2A or 2B completed requirement my Instructor's First Name is: * Required Information
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      Please provide your TI:ME Level 2A/2B instructor's first name for the second of three courses required from this level.
    23. For the second TI:ME 2A or 2B completed requirement my TI:ME Instructor's Last Name is: * Required Information
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      Please provide your instructor's last name
    24. On this date, I completed the course study for the second TI:ME Level 2A or 2B course. * Required Information
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      Please choose the data of completion
    25. I have completed TI:ME 2C Curriculum Integration studies
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    26. I completed my course study for the TI:ME Level 2C Course at this Institution or School: * Required Information
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    27. Fo the TI:ME Level 2C Course my Instructor's First Name is: * Required Information
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      Please provide your TI:ME Level 2C instructor's first name
    28. Fo the TI:ME Level 2C Course my Instructor's Last Name is: * Required Information
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      Please provide your instructor's last name
    29. On this date, I completed the course study for TI:ME Level 2C course. * Required Information
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      Please choose the data of completion
    30. After successfully completing this form and submitting payment for certification registration entry in the official TIME certification database you will be redirected to a confirmation page. You will also receive an email confirmation receipt of the submitted information exactly as your entered it into our Certification Registry system.

      Please retain the email you will automatically received for your records.
      If you use a Spam Filter, please whitelist the ti-me.org domain name to insure that you receive the email.
      If you wish to receive a print-quality personalized PDF certificate suitable for color printing and framing, please forward this emailed document to Mike Lawson, Executive Director of The Technology Institute for Music Educators and your certificate will be sent via email.

      Thank you for supporting TI:ME a 501 c3 Non-Profi Music Technology Education Organization.

    31. Today's Date of Application Submission * Required Information
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    32. By clicking on the Digitally Signed Affidavit of Applicant button, I hereby affirm and declare the submitted information to be complete and true. I understand that incomplete or false submissions may lead to my TI:ME membership being revoked and the withdrawal of my TI:ME Certifications
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