Certification Eligibility Curriculum Review Program Application

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1 Certification Eligibility Curriculum Review Program Application the American Nurses Credentialing Center (ANCC) offers the Certification Eligibility Curriculum Review Program (CECRP) to provide schools of nursing with an official confirmation of their nurse practitioner (NP) and clinical nurse specialist (CNS) programs congruence with educational eligibility criteria for national certification from ANCC. these requirements are based on the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education, which states that certification programs will assess the advanced practice registered nurse (APRN) core and role competencies across at least one population in graduate nursing programs. If your educational program meets the eligibility criteria on page 2, please proceed to the application process. Submit one complete application per APRN program at your school; additional APRN programs require individual, complete applications, documentation, and fees. Documentation Requirements: Include the naming convention for syllabi (NSG123). Include program overview listing all courses in the program. (1 2 pages) All documentation must be submitted electronically as separate Word or PDF files. Save all files in a zipped folder named with this format: School_Program. Please submit the application to: American Nurses Credentialing Center Attn: Certification Eligibility Curriculum Review Program P.O. Box 8785 Silver Spring, MD For more information about the Certification Eligibility Curriculum Review Program Application, please visit our website at or call

2 Eligibility Criteria 1 Institution must be a master's degree-, doctoral degree-, or postgraduate certificate-granting institution accredited by the Commission on Collegiate Nursing Education (CCNE) or by the National League for Nursing Accrediting Commission (NLNAC). 2 Each educational program must ensure that graduates are prepared for national certification and state licensure for the specific role and population. > Each educational program will focus on only one of the following two populations for CNSs: Adult-gerontology CNS (wellness through acute care) Pediatric CNS (wellness through acute care) > Each educational program will focus on only one of the following four populations for NPs: Family/individual across the lifespan Adult-gerontology (acute care) Adult-gerontology (primary care) Pediatrics (primary care) Psychiatric and mental health across the lifespan 3 Each educational program must include the following three separate, comprehensive graduate-level courses known as the APRN Core" or 3Ps : > Advanced physiology/pathophysiology, including general principles that apply across the life span > Advanced health assessment, which includes assessment of all human systems and advanced assessment techniques, concepts, and approaches > Advanced pharmacology, which includes pharmacodynamics, pharmacokinetics, and pharmacotherapeutics of all broad categories of agents 4 Each educational program must be broad based to include both clinical and didactic components to prepare the graduate to practice in the APRN role. 5 Each role must include preparation across the health wellness-illness continuum. 6 Each educational program must have a minimum of 500 clinical hours in role and population. 7 the following content should be integrated throughout each educational program: > basic understanding of the principles for decision making in the identified role > Preparation for responsibility and accountability of the APRN role in: Health promotion and/or maintenance Assessment, diagnosis, and management of patient problems Use and prescription of pharmacological and non-pharmacological interventions > transcripts or official school documents must identify: APRN role and population focus Completion of requirements for a postgraduate certificate in role and population, if applicable Degree conferred APRN Core courses 2 Certification Eligibility Curriculum Review Program Application

3 Certification Eligibility Curriculum Review Program Payment Page Please submit one application per APRN program; additional programs require additional applications, documentation, and fees. 1. GENERAL INFORMATION School Name Program Name 2. PAYMENT Fee = $1, per program (nonrefundable) Check/Money Order (payable to ANCC) Charge Card (MasterCard or VISA only) Amount Enclosed: Amount to be Charged: Check here if this is an AtM/debit card (see authorization below*) Promotional Code (if applicable): Account Number Expiration Date Print Name on Card Signature *ATM/debit card users only: I understand and agree that, by using an AtM/debit card, I am authorizing ANCC to debit my account for the amount specified above. Further, I understand and agree that, if the AtM/debit transaction fails or is declined, I am authorizing ANCC to complete the transaction as a credit card charge, if possible. 3. MAILING INSTRUCTIONS Detach this page and mail with payment to: American Nurses Credentialing Center Attn: Certification Eligibility Curriculum Review Program Application P.O. Box 8785 Silver Spring, MD Certification Eligibility Curriculum Review Program Application 3

4 Certification Eligibility Curriculum Review Program Application Please submit one application per APRN program; additional programs require additional applications, documentation, and fees. 4. PROGRAM TITLE title of Masters, Postgraduate, or Doctoral Program Name of College/University Street Address City State Zip Code 5. DEAN SCHOOL OF NURSING, OR DIRECTOR NURSING DIVISION/DEPARTMENT Name Credentials title Phone Fax 6. DIRECTOR OF APRN PROGRAM Name Credentials title Phone Fax 7. PRIMARY CONTACT PERSON Name Credentials title Phone Fax 4 Certification Eligibility Curriculum Review Program Application

5 8. DEGREE CONFERRED/AWARDED TO GRADUATING STUDENTS Name of Degree and/or Postgraduate Certificate Awarded What statements and/or documents are produced by the university to document that all required post-graduate coursework and graduate degree requirements have been completed? transcript Registrar s Certificate Other: 9. NAME OF NATIONAL NURSING ACCREDITING AGENCY AND DATES OF ACCREDITATION CCNE NLNAC Inclusive Dates for Accreditation: Inclusive Dates for Accreditation: 10. SUPPORTING DOCUMENTATION CHECKLIST Sample transcript for each program submitted (black out all identifying information) Dual program: provide information on courses and clinical hours that support each role and/or population Postgraduate program: provide a sample gap analysis Overview of curriculum Program description Course syllabi (each course in program) 11. EDUCATION Check the area of concentration completed: Adult-Gerontology Acute Care Nurse Practitioner Adult-Gerontology Primary Care Nurse Practitioner Family Nurse Practitioner Pediatric Primary Care Nurse Practitioner Psychiatric Mental Health Nurse Practitioner Adult-Gerontology Clinical Nurse Specialist Pediatric Clinical Nurse Specialist Master s Doctorate Postgraduate Certificate Is this a dual program? No Yes (If yes, please specify the role and population of the programs, and attach a detailed description of the content and clinical hours for each role and population. Please use letterhead and sign the attachment.) total Faculty-Supervised Clinical Hours: Certification Eligibility Curriculum Review Program Application 5

6 List the separate course numbers for the following courses: Advanced Course #: Physical or Health Assessment Course Appropriate #: Role (i.e., NP, CNS) For Nurse #: Practitioners: Appropriate Health Promotion/ Disease Prevention Advanced Course #: Pharmacology Course Appropriate #: Practicum For Nurse #: Practitioners: Appropriate Differential Diagnoses/ Disease Management Advanced Course #: Pathophysiology Course Appropriate #: Population- Focused (e.g. adult, family) For Psychiatric/ Modalities/ Mental Health #: Clinicians: List at Least 2 Psychotherapeutic treatment Modalities/ Courses 12. PROGRAM EXPECTATIONS AND REVIEW PROCESS Once required documents and fees are received, evidence is reviewed for completeness and program eligibility. (Please review eligibility criteria before submission.) During the evaluation process, additional evidence may be required to ensure that the program meets ANCC s APRN certification examination eligibility requirements. Be advised that eligibility does not equate with acceptance; all programs undergo a rigorous evaluation process by ANCC CECRP specialists. If approved, you will receive an of acceptance and official acceptance documents in the mail. If you are denied, a letter of explanation will be supplied with specific recommendations provided. Once accepted, the program must comply with all CECRP provisions, and notification may be advertised on the school s website with ANCC-approved language. these provisions, in addition to other important information related to CECRP acceptance, will be provided with official acceptance documents. 13. APPLICATION CHECKLIST Review eligibility criteria: Supporting documentation: If eligible, proceed to application process Overview of curriculum Application form: Program description (general) Completed in its entirety Course syllabi with course descriptions One application per NP or CNS program Dual programs: include detailed information $1, payment on the program structure for courses and clinical hours to support each role and/or population Postgraduate programs: provide sample gap analysis Sample transcript from graduate of program 6 Certification Eligibility Curriculum Review Program Application

7 14. STATEMENT OF UNDERSTANDING (Applicant) hereby applies to the American Nurses (insert educational program name) Credentialing Center (ANCC) for Acceptance in ANCC s Certification Eligibility Curriculum Review Program (CECRP). by signing below, I attest that I am duly authorized to make this application on behalf of. (insert educational program name) On behalf of Applicant, I hereby authorize ANCC staff and the Commission on Certification to make whatever inquiries and investigations that they, in their sole discretion, deem necessary to verify the information provided in or with this application and any other information necessary for review of this application and, if this application is granted and Applicant s curriculum is Accepted, to determine continued compliance with CECRP requirements. On behalf of the Applicant, I have read and understood the CECRP requirements. I hereby acknowledge and agree that Applicant is subject to all CERCP requirements and that initial and continued Acceptance of Applicant s curriculum by ANCC depend on successfully meeting all such requirements. If this application is granted, the Applicant s name, as it appears on this application, will be included in ANCC s official listing of Accepted Programs. On behalf of the Applicant, I acknowledge and agree that Acceptance by ANCC of Applicant s curriculum is not a guarantee that students who have completed the curriculum will be deemed eligible for or will receive any ANCC certification. I further acknowledge and agree that Acceptance of Applicant s curriculum may be used by ANCC, in its sole discretion, to make an expedited determination that students who have completed Applicant s curriculum, as outlined in this application, have satisfied ANCC s educational eligibility requirements for certification and (insert name of certification) that individuals who apply for certification must meet all (insert name of certification) ANCC certification eligibility requirements at the time they apply to be deemed eligible to sit for ANCC s examination and receive certification. (insert name of certification) I expressly acknowledge and agree that information accumulated by ANCC through the CECRP, including but not limited to Applicant s information, may be used for statistical, research, and evaluation purposes, and that ANCC may enter into agreements to release anonymous and aggregate data to third parties for such purposes. I hereby certify that the information provided on and with this application is true, complete, and correct. I attest, by my signature, that Applicant will comply with all CECRP requirements throughout the entire Acceptance period, including all renewal periods. I understand and agree that any misstatement of material fact submitted on, with, or in furtherance of this application shall be sufficient cause for ANCC to deny this application or revoke Acceptance and that ANCC, in its sole discretion, may report such misstatements to Applicant s accreditor. I understand that, while this application is pending and at any time during any Acceptance or renewal periods, Applicant may be required to submit documentation to support the information provided in this application and continued compliance with CECRP requirements. I further understand that, if Applicant fails to timely submit supporting documentation or demonstrate compliance, ANCC, in its sole discretion, may deny, suspend, or revoke Acceptance; deny or be unable to make expedited certification eligibility determinations of Applicant s students; and take other action, including but not limited to notifying Applicant s accreditors and other third parties. (Applications received without a signature incur a delay in processing.) Signature Print Name Date Certification Eligibility Curriculum Review Program Application 7

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