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Eligibility Requirements for Test Committee Membership:

  1. Must have ABPN certification in the specialty/subspecialty for which you are being considered
  2. Must have at least three years of clinical experience post-training in your specialty and, if applicable, in your subspecialty
  3. Must be actively participating in ABPN Continuing Certification (CC), including up-to-date completion of CC requirements in your ABPN Physician Portal
If you meet the above requirements, please proceed to complete the following application.

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* 1. Name

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* 2. Email address

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* 3. Phone

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* 4. Residential information

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* 5. Institution/employer information

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* 6. If you hold an academic/faculty appointment that is different from above

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* 7. What is your primary clinical practice setting?

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* 8. Select the committee(s) for which you have certification(s) and would like to be considered for membership

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* 9. Select the type of committee you want to be considered for membership (may select one or both types)

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* 10. Briefly describe your clinical interests, expertise, or foci

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* 11. Briefly describe your experience with educational programs or assessments, if any (please do not include your experiences solely as a student or trainee)

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* 12. Briefly describe your research or scholarly interests, if any

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* 13. Briefly describe your experience fostering Diversity, Equity, and/or Inclusion

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* 14. Please attach current CV. (File size limit is 16MB.)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 15. Please attach a one-page (maximum) cover letter that highlights any expertise or experience of relevance to ABPN test committee work, including any experience with exam question writing or other educational assessments. (File size limit is 16MB.)

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Choose File

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* 16. Referee – Please name an ABPN board-certified colleague whom we may contact regarding your interest in committee membership. This should be someone who knows you well enough to attest to your candidacy for ABPN test committee membership. (Please note, we will only ask them for an attestation, not for a letter of recommendation, to minimize any burden on their time.)

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* 17. Committee membership commitment: Please review the following documents
Responsibilities for Certification Examination Committee Members
Responsibilities for Article-Based Continuing Certification (ABCC) Committee Members

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* 18. Additional comments: (optional)

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* 19. My signature below confirms that I have answered all the above to the best of my ability and understand the time commitment and responsibilities of being a committee member, and if selected to serve, I will uphold my duties. I understand that my documents for committee membership consideration will be held by the ABPN for three years.

Please type your name below.

Candidates who are invited to join a committee will be asked to complete a conflict of interest form to identify any financial or fiduciary responsibilities that pose a real or perceived conflict of interest with the ABPN.

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