Note: The application must be filled out completely. When finished click on the submit button at the bottom of the form. To apply for CSHM you must document the required number of years of Professional Safety Work Experience. The application must include:
Typing your name and date on the signature line constitutes an electronic signature. Applications not completely filled out will not be considered.
You may mail this form to us at: 4841 East County 14 1/4 Street Yuma, AZ 85365. To print this form, right click the form and select Print.
ISHM is environmentally friendly and primarily uses email for day to day business purposes.
Use these fields to attach required documentation.
I certify that the statements above, together with any attachments, are accurate to the best of my knowledge. The institute is authorized to verify all information submitted. I fully understand that any falsification of information in this application or its attachments may be cause for rejection or withdrawal of certification consideration. I further understand that the institute shall be held harmless from any and all liability should this application be rejected on the basis of information provided hereon or by third parties, making me, in the judgment of the institute ineligible for certification.
By signing this application I acknowledge that I have read and agree to abide by the Code of Professional Conduct.
