ACS ERRA Enrollment Form

2026 ACS ERRA Enrollment Form
Please submit one enrollment form for each program you are enrolling in the 2026 ACS Entering Resident Readiness Assement^® (ACS ERRA). Even if the payor is the same, please treat dual programs as separate programs (e.g. Integrated Vascular vs. General Surgery). The deadline for enrollment is June 5th, 2026. You will be invoiced once the form is processed.
Did your program participate in the ACS ERRA last year ?*
How did you learn about the ACS ERRA?*

ACS Clinical CongressACS websiteAPDS conferenceEmail from ACSUtilized ERRA in the pastOther
Program Enrollment

Only entering PGY-1 residents are eligible. No administration on 6/19 as ACS is closed.
Program Specialty, if applicable
(example: Plastic, Thoracic, Urology, Vascular; if General Surgery or not applicable, leave blank)
Program Name*
as you would like the name to appear on your program's score reports
Enrollment Number*
Only entering PGY-1 residents are eligible.
Total Cost (USD) = $150 x # of residents*
The cost per resident is $150.
Administration Date (no administrations on 6/19 as ACS is closed)

MonthDayYear
No administrations on 6/19 as ACS is closed. If you do not yet know date or time, please leave blank.
Administration Start Time

Clock time (Hour : Minutes) Minutes

AM/PM Option
Time Zone*
Second Administration Date, if needed (no administrations on 6/19 as ACS is closed)

MonthDayYear
(No administrations on 6/19 as ACS is closed)
Second Administration Start Time, if needed

Clock time (Hour : Minutes) Minutes

AM/PM Option
Contact Details
ACGME Number*
Street Address*
Street Address, Line Two
Room Number, Suite Number, PO Box, Department Name, Etc.
City*
State/Province*
ZIP / Postal Code*
Program Director Information
Is your Program Director new this year?*
Program Director First Name*
Program Director Last Name*
Program Director Email*
example@example.com
Program Director Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Send the invoice to Program Director?*
Program Administrator Information
Is your Program Administrator new this year?*
Program Administrator First Name*
Program Administrator Last Name*
Program Administrator Email*
example@example.com
Program Administrator Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Send the invoice to Program Administrator?*
Additional email to receive communication (another contact, proctor, etc.):
example@example.com
You might also find value in the ACS SRRA (Senior Resident Readiness Assessment), a formative assessment on the clinical decision-making of your rising PGY-4 residents. Enrollment is open now.

Note: SRRA administration is earlier this year: May 4–June 12, 2026 (excluding May 25 for the holiday).
Do you also plan to enroll your rising PGY-4 residents in ACS SRRA?*

Yes (enroll at link above)No
If interested, would you like to schedule a brief SRRA demonstration of its benefits with ACS staff?

YesNot at this time
Please use this space to share any additional information regarding your ERRA enrollment or administration:
Should be Empty:

2026 ACS ERRA Enrollment Form

Program Enrollment

Contact Details

Program Director Information

Program Administrator Information