Neuroradiology Subspecialty Application

Neuroradiology Subspecialty Application
Application & Exam Fees
- If you were previously certified by the ABR in Neuroradiology, please contact the office at 520-790-2900 for instructions. This application is only for first-time applicants.
- Within 7-10 business days after submitting your application, you will receive an email from ABR staff notifying you that your application has been received, and instructions on paying the $640 application fee via myABR.
- Once the application fee has been paid, your application will be processed and reviewed.
- If your application is approved, you will receive an email notifying you of the approval, and instructions on paying the $1280 exam fees via myABR. The exam fee must be paid in order to register for the exam.
- If your application is not approved, you will receive an email outlining the reason your application was not accepted. You would then re-apply in the future when you meet the application requirements.
More information is available on the ABR website:
- Requirements and Registration
- Dates, Locations and Fees
Before you begin this form

You must have the following documents scanned and saved to your computer, as you will need to attach these within the application. You cannot save the application and return to it later.

If applying via the Standard/Fellowship Pathway:
- A copy of your fellowship certificate or an official letter (on letterhead) signed by your program director, documenting your ACGME-accredited neuroradiology fellowship training, including dates.
- An official letter (on letterhead) from your department head, documenting your post-training practice experience, with dates and percentage of time devoted to neuroradiology. (A minimum of 15 hours per week must be devoted to neuroradiology).
If applying via the Alternate/Practice Pathway:
- An official letter (on letterhead) signed by your department chair documenting your faulty experience. The letter must state that you are employed 1.0 FTE, with dates and percentage of time spent in neuroradiology.
  - Note, you must serve on the subspecialty faculty at a single institution with an ACGME- or RCPSC-accredited fellowship in the discipline for two consecutive years at 1.0 FTE, with at least 75 percent of clinical responsibility in neuroradiology, or at a single institution for three consecutive years at 1.0 FTE, with at least 50 percent of clinical responsibility in neuroradiology.
Name*

First NameMiddle NameLast Name
ABR ID*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
When did you receive your primary radiology certification?*
Month/Year
My name at the time of this certification was:*

The sameDifferent
If different, what was your name?
Before submitting an application, you must have attested in myABR to completion of the following MOC parts:

o Part 1: Professionalism and Professional Standing (state medical license)
o Part 2: Lifelong Learning and Self-Assessment
o Part 4: Improvement in Medical Practice (practice quality improvement project or activity)
I have completed my MOC Attestations.*

YesNo

Please indicate the pathway under which you are applying.*

Standard PathwayAlternate Pathway

Fellowship Program (Standard Pathway Only)
Institution *
City and State*
Began*

MonthDayYear
Date
Completed *

MonthDayYear
Date
Please list contact information for the program director of your neuroradiology fellowship:
Full Name*

First NameLast Name
Email
example@example.com
Submit one official letter (on letterhead) from your program director, documenting your ACGME-accredited neuroradiology fellowship training, including dates, or submit a copy of your fellowship certificate.*

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Post Fellowship Clinical Practice (Standard Pathway Only)*

	Institution	City/State	Average hours per week in Neuro	From	To
A
B
C
D

Submit one official letter (on letterhead) from your department head, documenting your post-training practice experience, with dates and percentage of time devoted to the subspecialty. (A minimum of 15 hours per week must be devoted to neuroradiology.)*

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Alternate/Practice Pathway
Please list contact information for the chair of your department:
Email
example@example.com
Full Name*

First NameLast Name

Faculty Member Experience (Alternate Pathway Only) *

	Institution (Please list current institution first.)	City/State	Average hours per week or percentage of time in neuroradiology	From	To
A
B
C
D

Submit one original letter (on letterhead) from your department chair, with dates, documenting your faculty experience and percentage of time spent in neuroradiology. *

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PLEASE READ CAREFULLY BEFORE SIGNING

Agreement for Candidates and Diplomates
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Neuroradiology Subspecialty Application

PLEASE READ CAREFULLY BEFORE SIGNING