TI:ME Certification Application Level 2CURRENT INDIVIDUAL MEMBERSHIP REQUIRED TO VERIFY AND PROCESS Register Your TI:ME Course Level Two Completion for Certification First Name - Req Last Name - Req Addess 1 - Req Address 2 City - Req State - Req Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands Zip Code - Req Country - Req United States Afghanistan Albania Algeria Andorra Angola Antigua & Deps Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia Herzegovina Botswana Brazil Brunei Bulgaria Burkina Burundi Cambodia Cameroon Canada Cape Verde Central African Rep Chad Chile China Colombia Comoros Congo Congo {Democratic Rep} Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland {Republic} nIsrael Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea North Korea South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar {Burma} Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russian Federation Rwanda St Kitts & Nevis St Lucia Saint Vincent & the Grenadines Samoa San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia nSouth Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Email Address - Req Phone - Req School Name or Professional Affiliation - Req I have successfully completed Levels One A and B and have been Certified by TI:ME - Req * Yes 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 - Req * 2A - Electronic Instruments 2A - Notation Software 2A - Advanced Sequencing 2A - Digital Media 2B - Multimedia Authoring 2B - Interactive Web Programming 2B - Digital Audio 2B - Advanced Digital Audio I completed my course study for the 1st required TI:ME Level 2 Course at this Institution or School - Req My first TI:ME Level Two Course was: - Req * 2A - Electronic Instruments 2A - Notation Software 2A - Advanced Sequencing 2A - Digital Media 2B - Multimedia Authoring 2B - Interactive Web Programming 2B - Digital Audio 2B - Advanced Digital Audio For the first TI:ME 2A or 2B completed requirement my Instructor's First Name is: - Req For the first TI:ME 2A or 2B completed requirement my TI:ME Instructor's Last Name is: - Req On this date, I completed the course study for the first TI:ME Level 2A or 2B course - Req My second TI:ME Level Two Course was: - Req * 2A - Electronic Instruments 2A - Notation Software 2A - Advanced Sequencing 2A - Digital Media 2B - Multimedia Authoring 2B - Interactive Web Programming 2B - Digital Audio 2B - Advanced Digital Audio I completed my course study for the 2nd required TI:ME Level 2 Course at this Institution or School: - Req For the second TI:ME 2A or 2B completed requirement my Instructor's First Name is: - Req For the second TI:ME 2A or 2B completed requirement my TI:ME Instructor's Last Name is: - Req On this date, I completed the course study for the second TI:ME Level 2A or 2B course. - Req I have completed TI:ME 2C Curriculum Integration studies - Req * Yes I completed my course study for the TI:ME Level 2C Course at this Institution or School: - Req Fo the TI:ME Level 2C Course my Instructor's First Name is: - Req Fo the TI:ME Level 2C Course my Instructor's Last Name is: - Req On this date, I completed the course study for TI:ME Level 2C course. - Req 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. Today's Date of Application Submission - Req 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 Submit Digitally Signed Affidavit of Applicant