Apply for ACRN certification

ACRN Eligibility

The following requirements must be met before seeking certification:

  • Currently licensed as a registered nurse in the United States or an international equivalent (a copy of your license must be submitted with your application)
  • At least two years of experience in clinical practice, education, management or research related to HIV/AIDS
  • Complete and submit an application
  • Pay required fee (ANAC members: $250, Non-ANAC members: $350)

Please complete all of the following required information and make your payment using Paypal. If you would like to pay without using Paypal, please complete the downloadable application. This application can be returned by fax to 330-670-0109, email or mail.

First name *
Middle initial
Last name *
Suffix
Preferred pronouns *

Clear Selection
Mailing address *
Apt/Suite
City *
State *
Zip code *
Email (If you have already created an account on the National HIV Curriculum, please use the same email address) *
Phone *
Current RN License Number *
License state *
License expiration date (mm/dd/yyyy) *

Eligibility and Background Information

Percent of working time currently spent in HIV/AIDS nursing *

Clear Selection
Primary position *

Clear Selection
Primary practice setting *

Clear Selection
Area of professional HIV/AIDS emphasis *

Clear Selection
Experience in HIV/AIDS nursing *

Clear Selection
Employment status *

Clear Selection
Primary practice location *

Clear Selection
Highest academic level *

Clear Selection
Other certifications held *
How did you hear about the ACRN program? *
Are you currently a member of ANAC/CANAC? *

Clear Selection
If yes, enter your member ID number
Are you currently or have you been certified in HIV/AIDS nursing? *

Clear Selection
If yes, please supply certification expiration date
Did you take any organized review courses prior to starting the certification process? *

Clear Selection

Optional Information

Race

Clear Selection
Age

Clear Selection
Gender

Clear Selection

Required Documentation

Please attach a copy of your current RN license(s) here. If you are unable to upload a copy of your license(s), a copy may be faxed to the national office at 330.670.0109.

File 1

Experience Validation

The person named below (my nursing supervisor or professional colleague), has completed the ACRN Supervisor Verification Form verifying that the above-named candidate for the Specialty Certification in HIV/AIDS Nursing Practice has a minimum of 2 years of HIV/AIDS nursing experience.

Name *
Supervisor Verification Form *

Candidate Agreement

Terms *
I have read and understand the requirements for candidate eligibility and the cancellation, rescheduling and no show policies. I affirm that all statements given on this application are true and correct to the best of my knowledge and that HANCB is hereby authorized to contact any organization or individual listed hereon to verify my education and licensure history.

Application checklist

Before submitting your application, did you:

  • Complete all required information on the application form
  • Upload a copy of your nursing license
  • Upload a copy of the Supervisor Verification Form
  • Pay the required application fee - Pay through Paypal now



Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

Certify

ReCertify

Merchandise

Contact

 
© 2022 HIV/AIDS Nursing Certification Board | 11230 Cleveland Ave NW #986, Uniontown, OH 44685
Phone: 800-260-6780 | Fax: 330-670-0109 | Email: hancb@anacnet.org