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Certification Application Submission Checklist
Before beginning the online application, use this checklist to review and prepare the information and attachments that will be required during the online application process. Complete eligibility criteria information is available on each subspecialty certification web page.
General Eligibility Information
Candidate Information
First, middle, and last name
Credential(s)
Birthdate
Home address and phone number
Work address and phone number
Preferred email address
Medical Education Information
Medical school name and location
Internationally Trained Faculty at a UCNS-Accredited Training Program applicants must have a medical diploma from an institution registered in the
World Directory of Medical Schools
Education start and end dates
Degree received
Date degree was received
Residency Training Information
Institution name(s) and location(s)
Specialty
Training start and end dates
Number of months of training
Full/part time
Board Certification Information
Name of certifying board(s)
Internationally Trained Faculty at a UCNS-Accredited Fellowship applicants must be certified in their primary specialty by a competent medical board. Such a board may include, a) an appropriate board of the European of Medical Specialties (EUMS), or b) the medical board of the applicant’s country of origin, such board to be approved by the Certification Council.
Certification number(s)
Issue and expiration date(s)
Medical Licensure Information
State/province of license
License number
Expiration date
License restrictions, if any
If license is restricted, must email explanation of restriction to
[email protected]
If license is pending, must email explanation of pending status to
[email protected]
Application Pathways
UCNS-accredited Fellowship
Name of UCNS-accredited training program
Start and end dates of fellowship
Number of months of training
Full/part time
Upload a copy of the
Fellowship Training Verification Template Letter
or a copy of fellowship completion certificate into the online application
Use template letter text provided on the
UCNS certification
page
Template text must be on institution letterhead
Letter must be signed by the program director
Practice Track
The practice track option is closed for some subspecialties. Check the eligibility criteria on the subspecialty certification web page to find out if this option is available.
Must provide required information for
one of three
practice track pathways:
Non-accredited Subspecialty Fellowship: Successful completion of non-accredited fellowship program that was 12 or more months in length
Name of training program
Start and end dates of fellowship
Number of months of training
Full/part time
Upload a copy of the
Fellowship Training Verification Template Letter
or a copy of fellowship completion certificate into the online application
Use template letter text provided on the
UCNS certification
page
Template text must be copied onto institution letterhead
Letter must be signed by the program director
Continuing Medical Education (CME): Completion of required
AMA PRA Category 1 Credit
TM
specifically related to the subspecialty within the 60 months prior to application. Please refer to your subspecialty eligibility requirements for the total number to be submitted.
Title of each CME program/activity
CME sponsoring organization
Start and end dates of each program/activity
Number of CME credits per activity
Academic Appointment: Applicant holds an active, full-time academic appointment teaching medical students, residents, and/or fellows in the subspecialty
Upload
Academic Appointment Verification Template Letter
into the online application
Use template letter text provided on the
UCNS certification
page
Template text must be copied onto institution letterhead
Letter must be signed by the department chair
In addition to one of the three practice track pathways, the following additional information is needed:
Practice Time Verification
Description of practice experience
Location of experience (city and state/province)
Start and end dates
Upload
Subspecialty Practice Time Verification Template Letters
from two physicians familiar with the applicant's practice into the online application
Use template letter text provided on the
UCNS certification
page
Template text must be copied onto verifying physician's practice letterhead
Confirmation of required practice time dedicated to the subspecialty
Practical Expertise Verification for Neuroimaging applicants only: Upload
one
of the following:
Upload a copy of valid certificate in MRI/CT from the American Society of Neuroimaging
Upload a copy of the
Neuroimaging Practical Expertise Verification Template Letter
confirming supervised or independent written interpretation of 650 Neuroimaging cases, at least 500 of which must be in MRI of the brain or spine into the online application.
Use template letter text provided on the
UCNS certification
page
Template text must be on institution letterhead
Letter must be signed by appropriate CME programs, mentors, medical directors, or program directors
Practical Expertise Verification for Clinical Neuromuscular Pathology applicants only
Upload a copy of the Clinical Neuromuscular Pathology Practical Expertise verification Template Letter from the applicant certifying that he/she has provided written interpretations of at least 100 nerve or muscle biopsies (with a minimum of 30 of either) during the 60 months preceding the application deadline into the online application.
Use template letter text provided on the
UCNS certification
page
Template text must be on institution letterhead
Letter must be signed by the applicant
Academic Appointment at a UCNS-Accredited Training Program
Applicant holds an active, full-time academic appointment teaching fellows in the subspecialty at a
UCNS-accredited training program
Upload
Academic Appointment Verification Template Letter
into the online application
Use template letter text provided on the
UCNS certification
page
Template text must be copied onto institution letterhead
Letter must be signed by the department chair
Practice Time Verification
Description of practice experience
Location of experience (city and state/province)
Start and end dates
Upload
Subspecialty Practice Time Verification Template Letters
from two physicians familiar with the applicant's practice into the online application
Use template letter text provided on the
UCNS certification
page
Template text must be copied onto verifying physician's practice letterhead
Confirmation of required practice time dedicated to the subspecialty
Internationally Trained Faculty at a UCNS-Accredited Training Program
Applicant holds an active, full-time academic appointment teaching fellows in the subspecialty at a
UCNS-accredited training program
Upload
Academic Appointment Verification Template Letter
into the online application
Use template letter text provided on the
UCNS certification
page
Template text must be copied onto institution letterhead
Letter must be signed by the department chair
Practice Time Verification
Description of practice experience
Location of experience (city and state/province)
Start and end dates
Upload
Subspecialty Practice Time Verification Template Letters
from two physicians familiar with the applicant's practice into the online application
Use template letter text provided on the
UCNS certification
page
Template text must be copied onto verifying physician's practice letterhead
Confirmation of required practice time dedicated to the subspecialty
Other Information
Special Testing Accommodations
If needed, complete
Special Testing Accommodations Form
Submit required supporting documentation of disability and previous testing accommodations by email to
[email protected]
Electronic Signature
Type name preceded and followed by a forward slash (e.g., /Jane Doe/)
Payment Options
Credit card (Visa, MasterCard, American Express)
Staff Contacts
Todd Bulson, Senior Manager Certification
[email protected]
(612) 928-6067
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