Certified Professional Insurance Woman/Man (CPIW/M)



Revised 12/02

Certified Professional Insurance Woman (CPIW)

National Association of Insurance Women (International)

Application Form (Please type or print clearly.)

Candidate Information (Name to appear on certificate)

Name_________________________________________________________________________________________

Mailing Address _______________________________________(Daytime Phone #) _________________________

City _______________________________________________ State ____________________ Zip _____________

Employer _____________________________________________________________________________________

Local Association ______________________________________________________ Region __________________

Education Requirements Refer to the back of this form for a list of eligible programs. Indicate below your qualifying programs and completion dates.

A. Non-NAIW Program Completion Date

If program was completed under a name other than your present name, please indicate such name.

_____________________________________________________________________________________________

Evidence of qualification – such as copy of final grade sheet, copy of certificate – must accompany application. If this is not available, it is the candidate’s responsibility to contact the program’s sponsoring organization and request a letter giving evidence and date of program completion.

B. NAIW Program ___________________________________________Completion Date ______________________

If program was completed under a name other than your present name, please indicate such name.

_____________________________________________________________________________________________

Evidence of completion for NAIW programs, must accompany application. Only Certificates of Completion issued by NAIW National are accepted. State CE forms are not accepted. Completion of an NAIW program is required only of those members joining NAIW on or after July 1, 1994.

Business Requirement Number of years employment in insurance industry

Would you like a letter acknowledging your accomplishment sent to your employer? yes no

If yes, Please print or type employer’s name, title and full address (Note: If there is no employer name and title, a letter will not be sent)

Membership Requirement Number of years membership in NAIW (International)

If a portion of this membership was held in an NAIW local association

other than your present association, please indicate such association.

If a portion of this membership was held under a name other

than your present name, please indicate such name.

Please send my certificate: Directly to me To my local association president

I hereby certify that the information provided on this application is true and correct.

Candidate’s Signature Date

If a special presentation of the certificate is planned and the certificate is to be mailed to other than the recipient, please complete the following:

Presentors name and mailing address:______________________________________________________________

________________________________________________________(Daytime Phone #)_____________________

Date of Presentation ________________________

| CERTIFIED PROFESSIONAL INSURANCE |[pic] |

|WOMAN (CPIW) DESIGNATION | |

The Certified Professional Insurance Woman (CPIW) designation was introduced in 1968 in direct support of NAIW’s stated goal of “promoting personal and professional development.” Attainment of the designation offers tangible evidence of high professional standards, a commitment to continuing education and an awareness of industry issues.

Today, the CPIW letters are proudly displayed after the names of more than one-third of NAIW’s members—proof positive of the association’s dedication to professional education as a means to professional advancement.

Application for the CPIW designation must be made on the official form available from NAIW headquarters. The requirements are:

✓ NAIW Membership. Membership in NAIW for a minimum of two years for those joining before January 1, 1990, and three consecutive years for those joining on or after January 1, 1990.

✓ Industry Employment. Employment in the industry for a minimum of five years.

✓ Educational Achievement. Completion of the two following educational requirements:

1. One of the following NAIW educational programs (for those joining on or after July 1, 1994.)

Rules of the Road Communicate with Confidence – 10 hour program Underwriting for Non-Underwriters

Leadership Development Mentors and Proteges How To Be A Best Seller

Successful Negotiations Life Insurance for Customer Service Representatives

I Can Series (to consist of one 4 hour program and 6 of the 30 minutes programs)

Sales Proficiency and Relationship Knowledge (SPARK) – 12 hour program

All programs must be a minimum of 6 hours to qualify (with the exception of the SPARK and CWC program). Rules of the Road, How To Be A Best Seller and Underwriting for Non-Underwriters are available as self study.

2. One of the following industry educational programs:

From American Institute for CPCU: Casualty-Property Claim Law Associate (CPCLA)

Chartered Property Casualty Underwriter (CPCU) Casualty-Workers’ Compensation Claim Law Assoc. (CWCLA)

From Society of CLU: Property-Workers’ Compensation Claim Law Assoc. (PWCLA)

Chartered Life Underwriter (CLU) Fraud Claim Law Specialist (FCLS)

From Life Office Management Association: Auto Claim Law Specialist (ACLS)

Fellow of Life Management Institute (FLMI) From The American College:

Associate in Customer Service (ACS) Registered Health Underwriter (RHU)

From Insurance Institute of Canada: From National Association of PIA:

Associate Rank (AIIC) Certified Professional Service Representative (CPSR)

From Life Underwriter Training Council: From Independent Insurance Agents of America:

Fellowship (LUTCF) Accredited Customer Service Representative (ACSR)

From Health Insurance Association of America: From Insurance Brokers Association of Canada:

Group Life and Health Insurance Canadian Accredited Insurance Broker (CAIB)

Health Insurance Associate (HIA) From Insurance Institute of America:

Managed Healthcare Professional (MHP) Certification in General Insurance (INS 21, 22 & 23)

From International Claims Association: Associate in Reinsurance (ARe)

Associate in Life and Health Claims (ALHC) Associate in Fidelity and Surety Bonding (AFSB)

From Society of Actuaries: Associate Rank Associate in Risk Management (ARM)

From National Alliance: Associate in Management (AIM)

Certified Insurance Counselor (CIC) Associate in Insurance Accounting and Finance (AIAF)

Certified Insurance Service Representative (CISR) Associate in Personal Lines (API)

Certified Risk Manager (CRM) Associate in Insurance Services (AIS)

From Casualty Actuarial Society: Associate Rank Associate in Surplus Lines Insurance (ASLI)

From Professional Liability Underwriting Society: Associate in Claims (AIC)

Registered Professional Liability Underwriting (RPLU) Associate in Loss Control Management (ALCM)

From Association of Average Adjusters: Full Membership Associate in Underwriting (AU)

From Int’l Foundation of Employee Benefits Plans: Associate in Premium Auditing (APA)

Certified Employee Benefits Specialist (CEBS) Accredited Advisor in Insurance (AAI)

From National Association of FIC: Associate in Information Technology (AIT)

Fraternal Insurance Counselor (FIC) Associate in Marine Insurance Management (AMIM)

From American Educational Institute: Associate in Research and Planning (ARP)

Senior Claim Law Associate (SCLA) From Society of State Filers:

Casualty Claim Law Associate (CCLA) Certified State Filer (CSF)

Property Claim Law Associate (PCLA) From American Institute of CPA’s:

Workers’ Compensation Claim Law Associate (WCLA) Certified Public Accountant (CPA)

Fraud Claim Law Associate (FCLA)

A $25 matriculation fee must accompany each application. To apply, simply complete and return the application as instructed on the reverse side of this form and join thousands of others who know that belonging to NAIW is good business.

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NAIW HQ Use Only

Cand. # _______ Assn # _______

NAIW Join Date ______________

Date Cert. ___________________

Please send the following: 1. Completed, signed application 3. $25 matriculation fee (US Dollars)

2. Documentary evidence of completion 4. Mail to: NAIW, Dept. 1400, PO Box 21820,

of education requirements. Tulsa, OK 74101-1820

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