AAP In-Service Exam Program Information and Administrative Requirements Agreement

This form should be filled out by each postdoctoral periodontal program administering the examination and submitted to the AAP by February 10, 2012. The information provided will be used to track and mail the examinations to your program.

Fields marked with * are required for submission of your program form.

Program Information
Program Director First Name*
Program Director Last Name*
Institution Name*

We would like the 2012 examinations mailed to:
First Name*
Last Name*
Address* (street address—no P.O. box)
City*
State/Province*      Zip/Postal Code*
Country (if not U.S.)
E-mail Address*
Phone Number* (###-###-####)

How do you plan to administer the 2012 Exam?
*As a closed-book, proctored exam on
*As an open-book exam on March 9, 2012

*I understand that each test candidate must complete an application and confidentiality agreement by filling out one of these forms, which must be submitted to the AAP by the candidates individually or by the institution:
2012 In-Service Exam Administrative Requirements Agreement
*I understand and will abide by the following requirements for administering the exam:
  • All exams will be administered within a one-week period – March 5-9, 2012
  • Open-book exams must be administered on the last day of exams.
  • Open-book exams will be given raw scores only and will not be included in the comparative scoring.
  • Take-home exams are not allowed.
  • All exams must be proctored, including open-book exams.
  • Exam booklets are not allowed to be taken out of exam room, except by the exam proctor.
  • Exam answer sheets must be mailed the day after the exam administration.
  • Exams must be kept in a secure and confidential location both prior to and after the exam administration until all of the programs have administered (the end of the day on the last day of the exam administration).
  • Prior to taking the exam, each examinee must complete an application and confidentiality statement that is submitted to the AAP by the candidates individually or by the institution.