AMERICAN BOARD OF ADOLESCENT PSYCHIATRY

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AMERICAN BOARD OF ADOLESCENT PSYCHIATRY SUPPORTED BY THE AMERICAN SOCIETY FOR ADOLESCENT PSYCHIATRY Candidate Guide & Certification Examination Application American Society For Adolescent Psychiatry P.O. Box 3948 Parker, CO 80134 Phone: (866) 672-9060 Fax: (720) 496-4974 E-mail: info@adolescent-psychiatry.org

Dear Colleague: Enclosed is an application for the certification examination in adolescent psychiatry offered by the American Society for Adolescent Psychiatry. Please take the time to read this letter and review the enclosed material. The future of psychiatric workforce may impact on your decision to obtain subspecialty certification. The current shortage and anticipated future shortage of psyciatrists interested in working with teens is well known, and identification as a general psychiatrist with sub-specialty certificate in Adolescent Psychiatry will likely enhance your standing among your colleagues in your area. Securing a Position: In response to a redefined need for adolescent psychiatrists, it is important for each practitioner to focus on his/her special interests and abilities and to communicate his/her competence in these areas to patients, colleagues and health care organizations. For board certified general psychiatrists invested in work with adolescents, certification by the American Society for Adolescent Psychiatry offers a way to do this. ASAP certification also demonstrates a commitment to the treatment of adolescents and their families. At this time, over 500 of your colleagues have obtained ASAP certification. Should you have any questions regarding the application process; please contact the ASAP office. Sincerely, Council on Certification in Adolescent Psychiatry Administrative Office P.O. Box 3948 Parker, CO 80134 Phone (866) 672-9060 Fax (720) 496-4974 E-mail info@adolescent-psychiatry.org

CANDIDATE G U I D E The certification examination for Adolescent Psychiatry is given once every year. Completed applications for the March 2018 examination must be received at the American Society for Adolescent Psychiatry (ASAP) office no later than February 1, 2018. The next examination is scheduled for: March 18, 2018 This will be concurrent to the Annual Meeting of the American Society for Adolescent Psychiatry. FEE SCHEDULE CERTIFICATES 1. The Added Qualification Certificate in adolescent psychiatry given by ASAP will be valid for ten years from the date of issuance. 2. Diplomates will be required to have their competence in adolescent psychiatry reassessed after ten years to maintain a valid certificate in adolescent psychiatry. 3. There is NO "grandfather" clause applicable for this certification. You must sit for the examination, regardless of how extensive your qualifications, to become a Diplomate. ELIGIBILITY REQUIREMENTS Registration Fee Examination Fee Re-Registration Fee $450 (a one-time non refundable fee, payable at time of application) $750 (payable upon admission to candidacy) $200 ( a one-time non refundable fee, for candidates who previously failed the examination) Each candidate for Added Qualification in Adolescent Psychiatry must comply with all of the following requirements: 1. He/she must be certified by either the American Board of Psychiatry and Neurology in general psychiatry or by the Royal College of Physicians of Canada in Psychiatry prior to applying for the examination. 2. He/she must hold a valid license for the practice of medicine in a state of the United States or in a province of Canada. Re-Examination Fee HISTORY $300 (payable at time of re-application) The American Board of Adolescent Psychiatry was founded to establish a formal basis for the field of adolescent psychiatry as a distinct area of subspecialization in psychiatry. Additionally, the American Society for Adolescent Psychiatry served to identify properly trained and experienced adolescent psychiatrists. The American Society for Adolescent Psychiatry recognized that psychiatrists certified by the American Board of Psychiatry and Neurology in Child and Adolescent Psychiatry meet the standards of competence expected of subspecialists in adolescent psychiatry. The American Society for Adolescent Psychiatry was established to offer a route to certification for psychiatrists with competence in treating adolescents who have not obtained formal subspecialty training in the treatment of children. In 2011, ABAP was reoganized under the auspices of the American Society for Adolescent Psychiatry (ASAP). 3. He/she must provide written documentation of 10 credit hours of continuing medical education in adolescent psychiatry in Category I of the Physicians Recognition Award of the American Medical Association within the year immediately preceding the examination OR must have satisfactorily completed training in an adolescent psychiatry program consisting of a minimum of a one-year fellowship in adolescent psychiatry beginning no sooner than the PGY-5 level. A letter from the candidate's training director describing the training and its successful completion must document this. The one year of specialized training in adolescent psychiatry may be completed on a part-time basis provided it is not less than half time, and must all be taken at a single training center. 4. He/she must spend at least 25% of patient care time treating adolescents and/or their families. 5. He/she must be an active dues paying (or exempt) member of ASAP.

CANDIDATE G U I D E APPLICATION AND FEES 1. All licensing requirements, for certification by the American Board of Psychiatry and Neurology in General Psychiatry or the Royal College of Physicians of Canada in Psychiatry, must have been met prior to making an application for the examination. 2. All candidates must complete, sign and submit to the Chairperson of the Council an application on the official form together with all required supporting data. Applications must be completed as indicated. If necessary, attach additional sheets. Reference letters are not required to accompany the submission of the application, but must be received at the ASAP administrative office within thirty (30) days of the date of your application. Additional application forms can be obtained from the ABAP office. 3. Each completed application must be accompanied by a check payable to ASAP in US funds for the one-time non-refundable registration fee of $450. No application will be processed without such pay ment. Payment of the examination fee of $750.00 in US funds will be due upon admission to candidacy. The examination fee is refundable at any time, less a $200 administrative fee, upon written notification of withdrawal from the scheduled examination. No refunds will be issued to any candidates choosing to withdraw less than thirty (30) days prior to the examination date. 4. No penalties are assessed against candidates postponing an application until the following administration; however, as noted above an administrative fee of $200 will be assessed against candidates withdrawing entirely from the examination process. Candidates wishing to postpone taking a particular administration must submit a request to the Council in writing not less than ten (10) days prior to an examination date. Candidates may only postpone to the following administration, and can only do so once. 5. Determination of a candidate's acceptability to sit for the examination will be made in accordance with the rules of the American Society for Adolescent Psychiatry. Your application must have all supporting documentation AND the reference letters before it can go to the Council Committee for review. The Council reviews completed applications, and the ASAP Executive Committee who vote whether to admit the candidate to the examination considers their recommendation. Candidates will be advised within six (6) weeks of the receipt of a complete application of their status. You are NOT eligible to take the examination until the Credentials Committee has approved your application. If for any reason the Council cancels the eligibility of a candidate for the examination, a full refund of the examination fee ($750) will be made. Both the application and your passport size photograph (only ONE photograph is required) must be signed. The completed application form should be forwarded to: American Society for Adolescent Psychiatry P.O. Box 3948 Parker, CO 80134 There is no grace period for receipt of your application. The application MUST be received by February 1, 2018 or it will be returned.

THE AMERICAN SOCIETY FOR ADOLESCENT PSYCHIATRY Application for Certification in Adolescent Psychiatry Mail completed application to: American Society For Adolescent Psychiatry P.O. Box 3948 Parker, CO 80134 ENCLOSE PHOTOGRAPH DO NOT STAP LE OR GLUE PHOTO OFFICE USE ONLY Application No. _ Date Received INSTRUCTIONS TO APPLICANTS: SSN: a. Please type or print all information. Each item in the application must bear an entry; if "none" is applicable, so state. Use extra sheets for additional data or information; identify the material being furnished and show your name and address on each sheet. Read instructions carefully. If the application is not completed properly, it will be returned. b. Enclose a passport style photograph of yourself, taken within the last two months, signed on the front with a ball-point pen. Photos must be at least 2x2 inches in size, full face, with no hats or scarves to be worn. c. Enclose a one-time non-refundable registration fee of $450. Make checks, money orders or cashier's checks payable to the American Society For Adolescent Psychiatry. Do not send cash or stamps. All currency must be in US dollars or its equivalent. (Upon admittance to candidacy, the examination fee of $750 will be payable.) d. A copy of the following documents must accompany this application: 1. Medical school diploma or official statement of valid MD degree from medical school. 2. Current state registration to practice medicine in one state, province or territory. 3. Certificate from the American Board of Psychiatry and Neurology or Fellowship of the Royal College of Physicians of Canada in Psychiatry. e. Reference letters are not required to accompany the submission of the application but must be received at the administrative offices within thirty (30) days of the date of your application. f. The completed application with all supporting documents must be received at the offices of the American Society For Adolescent Psychiatry, no later than February 1, 2018, for eligibility to take the examination. 1. Name ------------------------------------ Last First Middle Degrees: 2. Sex _ (M.D., D.O., etc.) 3. State your name exactly as you wish it to appear on the certificate: 4. If you have ever been known by or used another name (e.g., maiden name) please specify: 5. Mailing Address: Street/Apt/Suite No. City State Zip/Postal Code Office Tel: ( _ Home Tel: ( Fax:( E-mail: 6. Date of Birth. 7. Place of Birth: Month/Day/Year City/State/Country

P.O. Box 3948 Parker, CO 80134 Phone: (866) 672-9060 Fax: (720) 496-4974 American Society For Adolescent Psychiatry