Please type or print clearly. Submit the fully completed application to the ABN Application Coordinator by fax, e-mail or mail. See the web site for instructions: www.abn-board.com.

Note: Graduates of non APA/CPA accredited programs may demonstrate equivalency of doctoral training via listing in ASPPB/National Register Joint Designated Programs, by credentialing in the most recent directory of the National Register of Health Service Psychologists, or Canadian Register of Health Service Psychologists, or possession of the Certificate of Professional Qualification in Psychology issued by the Association of State and Provincial Psychology Boards (ASPPB CPQ)

Note: Candidates who did not complete an APA / CPA accredited, or APPIC-listed internship, and who are not credentialed by the National Register, may request that their internship supervisor(s) verify equivalency of their internship experience to National Register guidelines, by completing and returning the ABN Internship Guidelines Verification.

On or after January 1, 2005: Completion of the equivalent of 2 years of full-time postdoctoral education and training, on at least a half-time basis, that closely follows Houston Conference guidelines is required. Completion of a formal 2 year postdoctoral training fellowship, such as those offered by APPIC or AABN, is preferred but not required.

Between January 1, 1990 and December 31, 2004: Two or more years of supervised training in the application of clinical neuropsychological services, with participation in specialty-specific didactics is required. At least one year of training must be postdoctoral.

Between January 1, 1982 and December 31, 1989: 1600 hours of clinical neuropsychological experience supervised by a clinical neuropsychologist at the predoctoral or postdoctoral level is required.

Before 1982: 4800 hours of postdoctoral experience in a neuropsychological setting, involving a minimum of 2400 hours of direct clinical service is required.

Note: Senior Applicants (graduating prior to 2005) need not submit Post Doctoral Training Verification. However, a detailed description of the cumulative training experiences contributing to completion of requirements specific to your graduation era should be included in the Applicant Narrative accompanying this application.

If post doctoral training was completed at an APA / AABN / APPCN accredited site: GO DIRECTLY TO THE NEXT SECTION

Note: A minimum of 3 years professional experience in neuropsychology of which 1 year may be a supervised neuropsychology internship, with a minimum of 500 hours per year during the last 3 years providing neuropsychological services, is required.

Please answer the following questions:

If you answered yes to questions 1, 2 or 3, please enclose additional documentation in the Applicant Narrative accompanying this application.

Endorser 1

Endorser 2