2019 BOARD EXAMINATIONS APPLICATION

All applications must be submitted by 11:59 PM (PDT) on Friday, March 15, 2019.


Application Number:SYFJW-XBEZT-VXKZR-2GFAY-AEXTC

Record this number and keep it private.  You can use it to recover the application after closing your browser.


Please observe these requirements before completing the application:

  • All applicants may sit for both Part 1 (board qualification) and Part 2 (board certification) of the exam process in the same year but must pass Part 1 prior to sitting for Part 2.
  • All candidates with 24 months of CPME-approved residency training only, who achieved board qualified status and have passed case review by 2018 are eligible to continue to Part 2 of the certification process through 2020.

1. Exam Selection

If your intent is to sit for both part 1 and 2 in 2019, you may choose option 1 below and pay the designated amount with submission of your application by March 15, 2019.  If you do not pass part 1, you will receive a partial refund.

If your intent is to sit for part 1 only and apply for the certification portion shortly after receiving your results, you may do so, but the application fee is required for each submission.

If you are currently board qualified, you may submit your application for part 2 only by July 12, 2019


Application Deadline: March 15, 2019
$250 application fee is non-refundable upon receipt.
$750 is non-refundable after April 15, 2019.
Balance is non-refundable after September 7, 2019.
$1750.00


Application Deadline: March 15, 2019
$250 application fee is non-refundable upon receipt.
Balance is non-refundable after April 15, 2019.
$400.00


Application Deadline: July 12, 2019
$250 application fee is non-refundable upon receipt.
Balance is non-refundable after September 7, 2019.
$1600.00

2. Contact Information

All applicable fields are required.

   

 

     


3. Mailing Address

The address you enter must be a daytime address at which you can receive mail requesting a signature.  You may change your address at any time by informing us in writing.  If you are in residency, remember to advise ABPM of address and phone number changes after you complete your residency.

Address Line 1:
Address Line 2:
City:
State/Province:
ZIP/Postal Code:
Country:

4. Public Address

If you do not provide a second address, your mailing address will be used as your public address.  When you achieve either board qualified or board certified classification with ABPM, this address will be made available to the public.

Address Line 1:
Address Line 2:
City:
State/Province:
ZIP/Postal Code:
Country:

5. Education

Enter your 4-digit graduation year beside each school you have attended.


6. Postgraduate Experience

For each program you have completed, enter the date of completion and submit a copy of your residency certificate or, if currently in residency, provide a letter from your Residency Director confirming your program type, year, and expected date of completion. 

Add a Program


7. Minimum Activity Volume (MAV)

“I understand that I am required to attain all minimum activity volumes (MAVs) as set forth in the CPME 320 document to complete my residency program.  Failure to provide the certificate of residency completion may affect my eligibility to sit for the certification examination.”


8. Licenses

List all states in which you hold a podiatry license.  Upload a copy of each current license.

Add a License

Please note: in order to be granted board qualified status, you must have an active license and you must send a copy to headquarters once obtained.


9. Test Accommodations

ABPM is committed to providing access for all individuals with disabilities.  At the request of ABPM, Pearson VUE provides reasonable test accommodations for candidates with specific needs who provide timely and adequate documentation on a case-by-case basis.  It is essential for applicants requesting special accommodations to submit supporting documentation at the time of application submission.  That will assist, but not guarantee, the candidate obtaining accommodation at a test center proximate to their point of origin.

Special Accommodations Request.docx

“I am requesting special accommodations.”

Add a Supporting Document

ABPM will notify candidate via e-mail once accommodation is approved and advise them on how to schedule their appointment.


10. Ethics

1) Have any diciplinary actions been initiated and/or are any pending against you by any state licensure board?
2) Has your license to practice medicine in any state been denied, limited, suspended, revoked, placed on probation or involuntarily relinquished?
3) Have you been suspended, sanctioned or otherwise restricted from participating in any private, federal or state health insurance program (e.g. Medicare/Medicaid)?
4) Have you been the subject of any investigation by any private, federal or state agency including Professional Review Organizations, concerning you participation in any private, federal or state health insurance program?
5) Has your Federal DEA State Control Substance Certificate been denied, limited, suspended, revoked or involuntarily relinquished?
6) Have you ever been convicted of a felony or misdemeanor other than minor traffic violations?

If you answered Yes to any of the above questions, please explain:


11. Solicitation by Other Organizations

The ABPM will refer candidate information to organizations delivering educational content, or soliciting professional membership in areas relevant to the specialty unless specifically declined by the candidate.

“I do not wish my name to be provided to other organizations by the ABPM.”


12. Disclosure

“The information provided on or attached to this application is complete to the best of my knowledge.  I fully understand and agree that, as a condition of making this application, any misrepresentation, misstatements, or omissions, whether intentional or unintentional, may constitute cause for automatic and immediate rejection of this applications and/or membership classification achieved with the ABPM.”


13. Maintenance of Certification

“I understand that upon achieving Board Certification, I will be automatically enrolled in the ABPM Maintenance of Certification (MOC) Program.”  The enrollment fee for the MOC program is either a single payment of $1,635 or a payment plan of $200 annually.  (This is in addition to annual dues.)  The components and requirements of the MOC Program must be completed over a 10-year cycle.

Further information may be found on the ABPM website.



 

The American Board of Podiatric Medicine
1060 Aviation Blvd. #100
Hermosa Beach, CA 90254

Phone: (310) 375-0700
Fax: (310) 861-0445

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