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Annual Renewal Extension Request Form

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Annual Renewal Extension Request Form

Purpose

Personal Support Workers (PSWs) registered with the Health and Supportive Care Providers Oversight Authority (HSCPOA) must renew their registration by March 31st annually. A PSW certificate of registration with HSCPOA expires on April 1st annually, unless the PSW registrant has renewed their registration with HSCPOA or been granted a renewal extension.

HSCPOA is committed to supporting PSW registrants who are encountering challenging circumstances that limit their ability to renew their registration by the March 31st deadline date. In doing so, PSW registrants may request an extension to renew their registration of up to 30 days, or by end of day on April 30th, if one or more of the following circumstances exist:

  • current hospitalization,
  • prolonged illness,
  • disability,
  • bereavement,
  • personal hardship, or
  • Other circumstances that may limit the PSW registrant’s ability to complete their annual renewal by the annual deadline of March 31st.

Process

Please complete the Annual Renewal Extension Request Form below and attach any supporting documentation (if applicable) to explain your circumstances. Annual renewal extension requests must be received by HSCPOA at least five (5) business days before the March 31st annual renewal deadline date each year. If circumstances exist that prevent a HSCPOA PSW registrant from submitting their annual renewal extension request within these timelines, exceptions will be considered on a case-by-case basis.

HSCPOA PSW Registrant Personal Information

Name(Required)
Address(Required)
(The best number to reach you at)
Email(Required)
Please check the reason for your HSCPOA annual renewal extension request (check all that apply):
Max. file size: 16 MB.
I hereby declare that the information provided in this HSCPOA Annual Renewal Extension Form is true and accurate to the best of my knowledge. I understand that any misrepresentation or omission may result in my extension request being refused.(Required)
MM slash DD slash YYYY

Thank you for submitting your HSCPOA annual renewal extension request. HSCPOA staff will confirm receipt of your request within three (3) business days. You will be notified if additional information is required.

Pursuant to the Personal Information Protection and Electronic Documents Act, the personal information contained in this form will be kept private and confidential and used solely to assess your eligibility to be granted an extension under HSCPOA’s Annual Renewal Extension Request Policy.

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Have questions?

registration@hscpoa.com