| Community Bankers of Iowa (CBI)

* Indicates required field

Name *

First

Last

Title *

Bank Name *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

I have been or will have been employed as a community bank Lending Officer for three years on or by January 2017. Below is a summary of my employment history.

Company Name *

Company Location City & State *

Job Title *

Dates of Employment *

Phone Number *

Company Name *

Company Location City & State *

Job Title *

Dates of Employment *

Phone Number *

Company Name *

Company Location City & State *

Job Title *

Dates of Employment *

Phone Number *

Company Name *

Company Location City & State *

Job Title *

Dates of Employment *

Phone Number *

I have attended the following seminars and institutes provided by CBI during the past five years:

Name of CBI Seminar/Program *

Attendance Date(s) *

Number of Credit Hours *

Name of CBI Seminar/Program *

Attendance Date(s) *

Number of Credit Hours *

Name of CBI Seminar/Program *

Attendance Date(s) *

Number of Credit Hours *

I have attached letters verifying my participation in seminars provided through other organization(s).

Name of Providing Organization *

Attendance Date(s) *

Name of Seminar/Program *

Number of Credit Hours *

Name of Organization *

Attendance Date(s) *

Use the Upload File button to submit letters verifying your attendance at seminars or programs sponsored by organizations other than CBI. Files are accepted in the following formats: PDF, Word Doc (.doc or .docx), TXT, RTF, or Powerpoint. Compressed files containing multiple documents can be accepted in ZIP format.

Name of Seminar/Program *

Number of Credit Hours *

Upload File *

Max file size: 20MB

CBI will review your credentials and inform you as to whether or not you have met the education and employment requirements needed for consideration as a Community Bank Lender. If approved, CBI will send an invoice for the examination fee. Fees are $200 for CBI members and $300 for non-members.

I prefer to receive notification via: *

Email Regular Mail Phone

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