Certified Administrator Renal Healthcare (CARH) Certification Application
Administered by the Renal Healthcare Commission
Section 1: Applicant Information
Legal Name (Must match ID provided day of exam)
*
First Name
Last Name
Credentials (e.g., RN, MBA, etc.)
*
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
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Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Section 2: Eligibility Pathway
Eligibility Pathway:
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Option 1: Bachelor's Degree + 3 Years Experience + 3,000 Practice Hours (past 5 years)
Option 2: High School Diploma + 5 Years Experience + 5,000 Practice Hours (past 7 years)
Section 3: Education
Highest Earned Degree
*
High School Diploma or GED
Associate Degree (AA, AS)
Bachelor's Degree (BA, BS)
Master's Degree (MA, MS, MBA, etc.)
Doctoral Degree (PhD, EdD, etc.)
Other (Please specify)
If Other:
Institution Attended:
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Date Conferred:
*
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Month
-
Day
Year
Date
Section 4: Work Experience Verification
Employer Name
*
Position Title:
*
Supervisor Name and Title:
*
Date of Employment (From-)
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Month
-
Day
Year
Date
Date of Employment (-To)
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Month
-
Day
Year
Date
Employer Name
*
Position Title:
*
Supervisor Name and Title:
*
Date of Employment (From-)
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Month
-
Day
Year
Date
Date of Employment (-To)
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Month
-
Day
Year
Date
Employer Name
*
Position Title:
*
Supervisor Name and Title:
*
Date of Employment (From-)
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Month
-
Day
Year
Date
Date of Employment (-To)
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Month
-
Day
Year
Date
Have you completed at least 5,000 practice hours in the last three years or 7,000 practice hours in the last five years?
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Yes
No
Section 5: Application Fee
Applicant's will be invoiced within 3 business day upon RHCC receiving the application. Please contact customer service if an invoice has not been received or with follow up questions, info@renalcert.org. The collection of payment secures your seat the exam, not the submission of this application.
Are you a current member of RHA:
*
Yes ($350 Application fee )
No ($450 Application fee )
Provide Billing Information if Different From Above:
Section 6: Special Accommodations
Do you require Special Accommodations?
*
Yes
No
If yes, please Attach completed Appendix A Form from the Candidate Handbook or email to admin@renalhealthcare.org prior to the application deadline.
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Section 7: Attestation of Code of Ethics and Application:
As part of the application process, all candidates must attest to the following:
Code of Ethics Compliance: I affirm that I will uphold and adhere to the RHA Code of Ethics and will conduct myself in a manner that reflects the standards, values, and professional responsibilities of a renal healthcare administrator.
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I Affirm
Accuracy of Information: I certify that all information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any misrepresentation or omission may result in denial of eligibility, revocation of certification, or other disciplinary action.
*
I Affirm
Agreement to Certification Policies: I acknowledge that I have read and agree to comply with all policies, procedures, and requirements set forth by the Renal Healthcare Certification Commission (RHCC), including those related to eligibility, examination, recertification, and disciplinary action.
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I Affirm
Signature
*
Date
*
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Month
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Day
Year
Date
Auditing:
Please note: If randomly selected for an audit, you will be notified via email within 3 business days after payment has been processed. Auditing a percentage of applicants is required. Thank you in advance for complying.
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