File Appeal for Denial of Special Accommodations

Request for Appeal

Any certified person or person applying to become certified has a right to file an a complaint and/or appeal for valid complaints.

Fill out and submit the complaints form below.

Appeal Special Accommodations Decision

* Indicates required field

I am requesting an appeal of a recent decision made by ABCM on my behalf. Provide Initials. *

I attest that the information provided here is true and I am requesting a formal appeal in accordance with the ABCM's procedure on Complaints and Appeals. Provide electronic signature in the box provided. *

Today's Date *

Date of Examination *

First Name and Middle Initial *

Last Name *

Personal Phone Number *

Email *

I am appealing a recent certification decision by ABCM on the following frounds (check one): *

I was denied the ability to take an exam because ABCM claimed I was ineligible. I have concerns about my unsuccessful exam result, and would like it to be investigated. I believe that the test administration interruptions or errors caused by a proctor unfairly impaced the decision. The exam was rescheduled by the proctor, affecting my ability to take the exam. I require an extension of a deadline to accommodate a medical or personal emergency. I have a concrn over the denial of my recertification application.

Describe the reason you are applying for an appeal of ABCM's decision in more detail here.. *

Electronic Signature *

Submit