Sample Self-Chart

^{Affiliation
with the American Development and Consultants, Inc.}

^{Under
Cooperative Agreement with the National Transit Institute of Rutgers University.
AKA Associates, Franklin Covey, Leadership Dynamics, Dr. DiPalma Group}

Worksheet

This worksheet will give one an idea if they are eligible to take the type of certification exam that one is seeking. Take the time to print this chart and then return to the application review table to enter the information about yourself on this chart.

NAME_____________________ Certification Type (i.e.CTDVM^®):_____________	Enter Information Below (Sample information below)
Education	i.e. Masters
Points Credited	75
Experience	i.e. 10 years
Points Credited	60
Budget	i.e. $15 Million
Points Credited	30
Responsibility in % of time spent Internal ---------> External ---------->	i.e 50% 50%
Points Credited	30
Direct Reports	i.e. 6
Points Credited	65
Indirect Reports	i.e. 45
Points Credited	45
TOTAL POINTS	305

# 1. Application Review Sub-Total Above (i.e. 305) _______________

Next, look up the range of points required under the total points chart and write the minimum points required in the space below.

# 2. Minimum Range of points needed (i.e. CTDVM^® = 485) __________.

Enter #2 -->(i.e. 485) ____ (minus) Enter #1 -->(i.e. 305) ____ = (i.e. 280) ____ Exam Grade

This will give one a basic idea of what grade is needed on the exam in order to be considered for certification.

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