Program Information Form for Program Directors

Postdoctoral program directors or designee: Submit this form prior to Jan. 19, 2018.

Exam administration: Feb. 26 - March 9, 2018. All students at your institution must take the exam on the same day.

Open book exams: Must be administered on March 9, 2018.

Student Member rate:	$135
Non-Member rate:	$245

Residents may become Student Members by completing the Student Membership application. We suggest they become Student Members by Jan. 2, 2018, so their membership can be processed prior to their examination application.

Exam results: Results will be emailed to program directors during the week of April 16.

Members Only Content:

Not Member Only

WHERE EXAMS SHOULD BE MAILED

Institution Name: *

First Name: *

Last Name: *

Street Address: *

Address 2:

City: *

State: *

Postal Code: *

Country

Phone Number: *

Email Address: *

Program Director name (if different from above):

ADMINISTRATIVE REQUIREMENTS

The exam application/confidentiality agreement must be completed and signed by each examinee and submitted to the AAP by Jan. 19, 2018.
All students at your institution must take the exam on the same day from Feb. 26 - March 9, 2018.
Open-book exams must be administered on the last day of exams (March 9, 2018).
Open-book exams will be given raw scores only and will not be included in the comparative scoring.
Take-home exams are not allowed.
There must be a proctor in the room during the exam. Proctors can be an administrative assistant, a student from another program, etc.
Exam booklets and answer sheets are not allowed to be taken out of exam room, except by the exam proctor.
Exam answer sheets must be mailed to HumRRO the day after the exam administration.
Exams booklets can be kept after the exam for educational purposes, but must be stored in a secure and confidential location until after March 9, 2018.

Click to Confirm: *

I understand and will abide by the AAP's In-Service Examination rules and regulations above.

YOUR ADMINISTRATION OF THE EXAM

How do you plan to administer the 2018 Exam? *

I plan to administer the 2018 Exam as an open-book exam on March 9, 2018.

I plan to administer the 2018 Exam as a closed-book, proctored exam on:

Date of closed-book exam:

EXAM PRICING

Student Member rate: $135

Non-member rate: $245 (Any residents/students who are non-members and wish to become members must complete the student member application and pay dues before submitting the In-Service Exam application.)

Number of AAP Student Members ($135 each): *

Number of Student Non-Members ($245 each): *

If no non-members enter zero.

Total number of students taking the exam: *

Total cost: $

PAYMENT AND CONFIRMATION

Payer

Our residents/students will pay for their own examination fees

Our institution is paying for our residents/students

Payment Method

Credit card

Check

Institution paying with credit card: Submit the completed program information form by clicking on the link below. You will receive an email with a link to pay the examination fee(s) via a secure credit card payment website after the exam applications are processed.

Institution paying with check: Submit the completed program information form by clicking on the link below. Mail the program information form, the completed application(s), and your check to American Academy of Periodontology, Academic, Regulatory Affairs & Advocacy Department, 737 N. Michigan Avenue, Suite 800, Chicago, IL 60611. Payments must be made within 2 weeks.

You will receive a payment confirmation email after your payment is processed. Application processing may take three to four business days.

Click to confirm: *

I will follow the above payment process that is required to take the In-Service Exam.

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Program Information Form for Program Directors