Please note that the application must be completed and in the hands of the Credentialing Committee by April 1st for review at the June Board meeting or by October 1st for review at the December Board meeting. A recertification application fee in the amount of $375 is due at the time of application and payable on the ABPNS website. If your application is approved by the Board, you will be eligible for the joint ABNS-ABPNS focused practice document (certificate) once proof of completion of ABNS continuous certification requirements are met for your recertification year. If your application is incomplete or received after the deadline date, your application will be processed at the subsequent board meeting. Please submit this application and the supporting documentation listed above electronically via e-mail to kbollerman@abns.org. By signing below, I hereby verify that all information submitted in this application for recertification by the American Board of Pediatric Neurological Surgery is true, accurate and completed to the best of my knowledge and belief. I hereby request recertification by the American Board of Pediatric Neurological Surgery. I understand that recertification will require the submission of an operative case log and the successful completion of the ABNS continuous certification requirements. Electronically signed by: _____________________________ (type in your name to verify above) Date: ______________ ABPNS Administrative Area only: Current Membership Status: _______________________________________ ABPNS Expiration Date: ___________________________________________ Case log provided in proper format in format. No case log due to certified-inactive status. Paid Recertification Fee ABNS CC Status: _________________________________________________
Please note that the application must be completed and in the hands of the Credentialing Committee by April 1st for review at the June Board meeting or by October 1st for review at the December Board meeting. A recertification application fee in the amount of $375 is due at the time of application and payable on the ABPNS website. If your application is approved by the Board, you will be eligible for the joint ABNS-ABPNS focused practice document (certificate) once proof of completion of ABNS continuous certification requirements are met for your recertification year. If your application is incomplete or received after the deadline date, your application will be processed at the subsequent board meeting. Please submit this application and the supporting documentation listed above electronically via e-mail to kbollerman@abns.org. By signing below, I hereby verify that all information submitted in this application for recertification by the American Board of Pediatric Neurological Surgery is true, accurate and completed to the best of my knowledge and belief. I hereby request recertification by the American Board of Pediatric Neurological Surgery. I understand that recertification will require the submission of an operative case log and the successful completion of the ABNS continuous certification requirements. Electronically signed by: _____________________________ (type in your name to verify above) Date: ______________ ABPNS Administrative Area only: Current Membership Status: _______________________________________ ABPNS Expiration Date: ___________________________________________ Case log provided in proper format in format. No case log due to certified-inactive status. Paid Recertification Fee ABNS CC Status: _________________________________________________
The%20American%20Board%20of%20Pediatric%20Neurological%20Surgery%20-%20Recertification%20Application.docx