Board Qualified Status Extension Request Form

Name:*

First NameLast Name

ABFAS ID:*

Email:*

example@example.com

Phone Number*

Please enter a valid phone number.

For which status type(s) are you requesting an extension?*

Foot Surgery Status OnlyRRA Surgery Status OnlyBoth Foot and RRA Surgery Status

Please note: You may only submit extension requests in your final year of Board Qualified status.

Extension Request Reason*

Family (family support, caregiver, pregnancy, maternity/paternity leave, etc.)Professional (career changes/moves, unemployment, lack of surgical cases, etc.)Health (personal health issues, non-pregnancy/family member care)COVID (COVID-19 surgical case delay or other impact on practice/life)Exam (exam registration or eligibility issue, case documentation issue, or exam concern)Fellowship (surgical case accrual delay due to one or two-year fellowship after residency)

Extension Request Details*

Explain in detail the extenuating circumstances that require an extension of your Board Qualified status.

Upload Supporting Documentation

Provide any additional documentation that supports your extension request (e.g., hospital privileges, license documentation, etc).

NEW CBPS Registration Exception Request

If you became Board Qualified before September 2020, you must still fulfill the Part II exam requirements that were in effect at that time to become Board Certified: namely, passing the Part II CBPS or NEW CBPS and passing Case Review. Candidates who have not previously fulfilled the Part II CBPS Examination requirement must take the NEW CBPS Examination. Those with Residency Program completion 2020 and earlier are only eligible to take the NEW CBPS exam during the Spring exam window. If you would like to request an exam registration exception for the Fall exam window you can do so below:

Registration exception for the Fall NEW CBPS Exam?

Yes, NEW Foot Surgery CBPS ExamYes, NEW RRA Surgery CBPS ExamNo, I do not need a NEW CBPS Exam registration exception.

Please note: Submission of a request for an extension does not guarantee approval. ABFAS has discretion to approve or deny each request. The ABFAS Board of Directors determines whether to approve each properly submitted extension request, each of which is presented to the Board anonymously, with all personally identifiable information redacted.