Exam Application

All Course/Exam Applications

This Course/Exam Application is used for all applicants no matter which Course or Exam they may be applying for. It is the mandatory first step in becoming board certified and needs to be given careful attention to accurate answers to the questions in the application. Improperly filled out applications will be delayed. The applications are being processed within a week in most cases. Thank you for your application; you should have already made your payment for the Course/Exam.

Answer all questions in this application in order to have your application considered without delay.

As of August 5, 2020, anyone applying to sit for a Board Certification Examination, must submit a legible copy of a State issued valid ID or passport along with their application - no exceptions. Scan and send to our course registrar Bobbi Lucido at abcm.lucido@gmail.com. Many people have been giving us multiple names they go by and this is not acceptable for Course and Certification Exam applications; please provide your legal name and ID.

* Indicates required field

Application: Indicate Location and name of Review Course if Attending prior to sitting for your Exams (Online or at a live location such as Plainview, NY; Houston, TX; Los Angeles, CA, Etc., Indicate below in space provided). *

First Name, Middle Initial, and Last Name *

First

Last

Professional Title: Use Dropdown box to locate your title *

Home Address (include apt. no if applicable) *

City, State or Province *

Country *

Zip Code or Other Country Code *

Identify your gender for your certificate *

Home Email *

Work Email *

Home Phone (cell preferred) *

Work Phone *

Professional License Number *

State where license issued: *

Name of College where you received your medical, NP, PA, nursing, or technical training *

Location of College or Technical School where you received training: City, State, Province, Country *

Year of graduation from College or Technical School *

Degree or Certificate Obtained in College or Technical School *

Other Certifications Held *

Employer Name: Example St. Luke's Hospital, etc. *

Name of Direct Supervisor *

What Area of Cardiology do you work in? *

How many years experience in cardiology do you have? *

How were you trained in cardiology? Self Taught, College Course, Conferences, Online, etc. *

Are you an educator? *

Submit