In-Service Exam: Program Information Form

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This online form should be submitted by January 25, 2013, only by postdoctoral periodontal programs administering the exam and NOT paying students' exam fees.

If your program is paying students' exam fees, you must fax or mail the printable Program Information Form and a copy of the printable application and confidentiality agreement completed and signed by each student, along with full payment by check or credit card. These materials must be submitted to the AAP by January 25, 2013.

Application Deadline: January 25, 2013
Exam Administration: March 4-8, 2013

Members Only Content:

Not Member Only

Program Director First Name: *

Program Director Last Name: *

Program Director's Email: *

Institution Name: *

WHERE 2013 EXAMS SHOULD BE MAILED

First Name: *

Last Name: *

Institution Name: *

Street Address: *

(No P.O. Box)

City: *

State: *

Postal Code: *

Phone Number: *

Email Address: *

YOUR ADMINISTRATION OF THE EXAM

I plan to administer the 2013 Exam as an open-book exam on March 8, 2013

I plan to administer the 2013 Exam as a closed-book, proctored exam on:

How many of your students will take the 2013 exam: *

Names of students taking the exam *

Enter full names separated by commas

ADMINISTRATIVE REQUIREMENTS

•All exams will be administered within a one-week period – March 4-8, 2013. •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. •There must be a proctor in the room during the exam. Proctors can be an administrative assistant, a student from another program, etc. •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). •An exam application and student confidentiality agreement must be signed by each examinee and submitted to the AAP prior to taking the exam.

Click to Confirm: *

I understand that each test candidate must complete an Exam Application and Student Confidentiality Agreement.

I understand and will abide by the AAP's In-Service Examination rules and regulations above.