Unique Qualifications Application and Instructions
All applications must be submitted and all eligibility requirements completed by:
December 31, 2008.
ABC will no longer be accepting applications after this deadline.
Important: Read the following instructions carefully before completing this application. Incomplete or improperly completed applications will either delay processing and/or render the application ineligible. You are requested to photocopy all forms in advance in the event you need additional copies or make an error. Complete the application and registration form in their entirety.
A) Refer to the Unique Qualifications Practitioner Certification Book of Rules for information on the criteria for certification and the application process.
B) All requirements, educational and experiential, must be met prior to the deadline date, September 1, 2006 for the Fall/Winter 2006 examinations.
C) Applications must be submitted on current forms which are revised for the forthcoming examination session. Dates of the examination session for which the application is applicable are indicated on the top right corner of this page.
D) Applications must be typewritten. Applications which are not typewritten will be returned.
E) A completed registration form must accompany your application. New applicants must register for at least one examination at the time of application. Applicants may elect to register for all three examinations within the same exam session. Registrations for the Clinical Patient Management examinations are taken on a "first-come, first-serve" basis. The three examinations are independent of each other and scored separately. The exams may be taken in any order.
F) Retain a copy of the completed application and registration form for your records.
G) Enclose the current application fee ($250.00) and the appropriate examination fee(s). Make check, certified check or money order payable to The American Board for Certification in O&P. All fees may be remitted on one check. Credit card payments are accepted. Please record method of payment on the payment form.
H) Mail your application to ensure delivery by the deadline. Please note: The U.S. Postal Service is the only express mail service that can deliver to a "Department" address.
I) Applications and all requested documentation must be received by the application deadline. Late applications will be returned.
J) Applications will not be reviewed over the telephone. Applications take approximately eight weeks to process from the date of the application deadline. Applicants will be notified in writing with regard to eligibility.
K) The following documentation and fees are required as part of the official application:
The Application
Application fee ($250.00). The application fee is non-refundable. A $25.00 fee will be assessed for any check or credit card number returned to ABC for any reason.
General Information form. Indicate your demographic information and the pathway you are applying for on this form. Those applying for the 10-year pathway must list their education on this form. Transcripts/credit reports must be included with the application. Those applying for the 10-year pathway must include a copy of their high school or GED diploma.
Experience form. Copy this form in advance as necessary. List each separate segment of employment experience. The experience listed must total the number of years required for the pathway for which you are applying.
From the Unique Qualifications Book of Rules:
ABC reserves the right to ask applicants to furnish such information and/or make such inquiries as may be deemed appropriate to identify the nature and extent of the applicants education, experience, competency, moral character and reputation. Discovery that an applicant or attester has falsified any information on the application shall lead to any or all of the following actions:
Rejection of the application Barring the applicant from examination Revocation of any existing ANC certification status of the applicant or attester Reference of the incident to the Professional Discipline Committee
Case History form. Copy this form in advance as needed. Use this form to document the scope of experience in the discipline in which certification is sought. Documentation will be provided through case histories as required for the pathway you have chosen. Carefully read the requirements for the case histories and complete the form(s). The form must thoroughly document the evaluation, clinical assessment, treatment and outcome for each history. The case histories must be for separate patients, no single patient history may be provided for more than one pathology. DO NOT use the patient's name or other manner of identification on the case history form.
Custom designed prostheses: Experiential level must include the following amputation levels: transtibial, transfemoral, transradial, transhumeral, partial foot and symes. Applicant must present 12 case histories. Of the 12 required, 2 must be transtibial, 2 must be transfemoral, and the remainder must represent at least one each of the remaining amputation levels listed.
Custom designed orthoses: Experiential level must include the following orthoses: Foot orthosis, AFO, Knee Orthosis, KAFO, Hip Orthosis, Cervical Orthosis, TLSO, LSO, WHO and SEO. Applicant must present 22 case histories to include 2 each of the first four orthoses listed above. The remainder must represent at least one each of the remaining orthoses listed above. The case reviews must include at least 2 extremity fracture management orthoses. The spinal orthosis must include at least two of the following: instability, deformity and/or pain.
Letters of Recommendation. Use this form to list the names of the individuals who are writing letters of recommendation for you. Applicant must submit letters of recommendation in support of competency in the discipline for which certification is sought. The recommendations must be submitted from individuals located within the community served by the applicant, and must be dated within one year of the application date. The following are required:
2 recommendations from ABC-certified colleagues. If unavailable, you may submit two additional letters from referral sources 2 recommendations from current patients. 2 recommendations from referral sources.
The letters must be in a sealed envelope and enclosed with the application.
Continuing Education form. Use this form to list the continuing education activities in which you have participated within the past two years. Attach evidence of participation in the activity to the form. Evidence may include: copy of certificate of completion, copy of sign-in sheet, a receipt for registration fees paid, letter verifying attendance from sponsor, or copy of activity program.
Additional Achievements form. Use this form to list additional achievements to support your application for eligibility. All achievements listed must be related to the discipline in which certification is being sought. This may include but is not limited to: academic endeavors including teaching/lecturing, research and development; papers and other scientific publications; other credentials awarded and special awards or recognitions.
The Registration Form
Examination Registration form. Complete this form to indicate the examinations for which you are registering.
Examination fee(s).
| • |
Written exam |
$250.00 |
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| • |
Written Simulation exam |
$250.00 |
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| • |
Clinical Patient Management exams |
$600.00 |
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First-time applicants must also remit the non-refundable $250.00 application fee.
Payment form. Complete this form to record your method of payment.
This document is available
in 1 downloadable format.
Unique Qualifications Application
(PDF)
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