Apply for ACRN recertification

Complete and attach the continuing education documentation with your application.  Your application is be considered incomplete and will not be processed without this documentation. For a complete list of approved continuing education activities, please click here. Please complete all of the following required information and make your payment using Paypal.If you do not have a Paypal account, you may make payments as a guest user without creating an account. 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.

Title
First name *
Middle initial
Last name *
Suffix
Mailing address *
Apt/Suite
City *
State *
Zip code *
Email *
Phone *
Date of initial certification (MM/YYYY) *
Have you recertified your ACRN before? *

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ACRN certification number *
Current RN License Number *
License state *
License expiration date (mm/dd/yyyy) *
Is your RN license in good standing in all jurisdictions in which you are currently licensed as a RN? *

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During the past four years, has any action been taken against your RN license? *

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Eligibility and Background Information

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

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Primary position *

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Primary practice setting *

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Area of professional HIV/AIDS emphasis *

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Experience in HIV/AIDS nursing *

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Employment status *

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Primary practice location *

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Highest academic level *

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Other certifications held *
Are you currently a member of ANAC? *

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If yes, enter your member ID number

Optional Information

Race

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Age

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Gender

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Required Documentation

Please attach the completed Continuing Education documentation form, your supporting documentation if you have been randomly selected for audit and any necessary licensure explanations below. A minimum of 70 CEPs are needed for recertification. Find the full ACRN recertification policies and procedures 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
File 2
File 3

Candidate Agreement

Terms *
I affirm that all statements given on this application are true and correct to the best of my knowledge and that the HANCB is hereby authorized to contact any organization or individual listed hereon to verify my continuing education or licensure history.






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Contact

 
© 2020 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