PERSONAL INFORMATION:
Last Name:
First Name:
Address:
City:
State:
Zip:
Email:
Daytime Phone:
Church Information:
Church Name:
Pastor's Name:
Church Address:
City:
State:
Zip:
Church Fax
Church Phone:
Church Email:
Electronic Signature Requirements:
By checking this box, I certify that the UPCI Pastor above has approved and will endorse me for the Life In
Focus Education certification.  

By checking this box, I certify that all information submitted with this renewal is accurate and complete. I
understand that providing false information may result in revocation of my license and the imposition of
administrative penalties.
PLEASE NOTE:  Once you have hit the submit button you will receive a confirmation page.  Once you
receive the confirmation you will be redirected to the store to purchase the Renewal Certification for $20.  
This is located in the Certification tab in the Life In Focus Store.
ONLINE Renewal APPLICATION
Life in Focus Education
Renewal Application
Renewal fee is $20.  

Only the endorsements on-file will renew that are less than 3 months past the expiration date. If over 3 months,
but not more than 6 months past the expiration, the renewal fee is $25.

After December 31, 2011, all renewals that are more than a year old MUST complete the CORE and
Specialized training.