cci 2013 subscription program application...
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CCI 2013 Subscription Program Application Form
Page 1 of 3
Revised December 2012
Only individuals, who meet all requirements for the Citrix Certified Instructor (CCI) certification, including membership in the 2013 Subscription Program, are authorized to teach Citrix professional courseware. Please complete and submit this form following the directions provided. Your membership in the Subscription Program will be finalized once you receive an email notification from Citrix Education. For a complete list of Subscription Program benefits, click here.
Candidate Information: Please provide the following information. Name Company Name Address Telephone Fax E-mail MyCitrix Username Candidate ID (Cert. Mgr)
Which one best describes you?
I am an independent CCI.
I am a CCI who works for a Citrix Authorized Learning Center (CALC).
Please identify which CALC(s) you will be teaching at in 2013 (list all, including location): _____________________________________________________________________________________________________ Please tell us about the Citrix products you are most familiar with teaching and implementing. _____________________________________________________________________________________________________
CCI 2013 Subscription Program Application Form
Page 2 of 3
Revised December 2012
Please check the applicable CCI 2013 track (please check all that apply):
CCI 2013 for Virtualization
CCI 2013 for Networking
* Please note that you will be required to complete all related certification requirements for the applicable CCI 2013 track(s) to maintain your eligibility to teach Citrix Authorized Courseware.
Please note that in order to register for the CCI 2013 Subscription Program, CCI candidates must meet all requirements for the program as prescribed by Citrix Education, including any region specific requirements, within the timelines prescribed. These requirements will be made available to you through the Citrix Education representative in your region. They will also be posted on the Citrix Education website. You may view your progress toward your CCI 2013 certification via the Certification Manager at www.citrixcertmanager.com. Please complete the following actions to maintain your eligibility to teach Citrix Authorized Courseware:
Complete all related certification requirements for the applicable CCI 2013 track(s)
Citrix virtualization instructors only— Log-in to Certification Manager. Review and accept the CCEE Legal Agreement. This is part of the CCEE certification for instructors.
Complete this CCI Subscription Application form and send the form with your payment and a copy of your industry trainer certificate(s) and third-party certificate(s) (if applicable) to your Citrix Sales Representative (contact information below).
AMS, EMEA, and APAC only--Log-in to Certification Manager. Review and accept the 2013 CCI Agreement.
Japan only—Log-in to Certification Manager. Indicate that you have submitted your signed 2013 CCI Agreement to Tomoe Matsudaira by checking the 2013 CCI Agreement box
CCI 2013 Subscription Program Application Form
Page 3 of 3
Revised December 2012
Payment Method: The application fee for the CCI 2013 Subscription Program is $500 (USD). The application fee is due at the time of application. Payment is accepted in the form of check, credit card (Visa/MC/AMEX), or PO (AMS, EMEA, & Japan).
o If paying by check, please include the signed check with your application form. o If paying by credit card, please provide the following information along with the authorized signature. o Payment can be received by Purchase Order (PO) in AMS, EMEA, and Japan
Card Type (Visa/MC/AMEX) Card Number Exp. Date Name on Card (print name) Authorized Signature Candidate Signature: Please print and sign your name below verifying that the information provided is accurate and correct. Then mail or fax the application form along with supporting documentation to the appropriate contact listed below. Candidate Name Candidate Signature
North America Citrix Systems, Inc. 851 West Cypress Creek Road Fort Lauderdale, FL 33309 Contact: Americans EducationEmail: [email protected] Tel: 954-267-2407 Fax: 954-229-6695
Latin America/Caribbean Citrix Systems, Inc. 851 West Cypress Creek Road Fort Lauderdale, FL 33309 Contact: Americans EducationEmail: [email protected] Tel: 954-267-2407 Fax: 954-229-6695
Europe/Middle East/Africa Citrix Partner Operations 15 Beaufort Court Roebuck Way Knowlhill Milton Keynes MK5 8HL United Kingdom DDI 01908 398 557 Switchboard 01908 398 550 Fax: 01908 398 551 Contact: Mona Bhatia [email protected] Completed application form for processing to: [email protected]
Pacific Citrix Systems Asia Pacific Pty Ltd. Level 3, 1 Julius Avenue Riverside Corporate Park North Ryde, NSW 2113 Australia Contact : Nicholas Thomas Email: [email protected] Tel : +61 2 8870 0615
Japan Citrix Systems Japan KK 24F CommonGate West Tokyo, Japan Contact: Tomoe Matsudaira Email: [email protected] Tel: + 81-3-4577-5788 Fax: +81-3-4577-5920