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The Association for Surgical Education

The Association for Surgical Education

Impacting Surgical Education Globally

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Academy of Clerkship Directors Application Form

SUBMISSION DEADLINE: January 4, 2021 12:00 PM PST

Verification Process Details:

To obtain certification an applicants must be active ASE members (all dues paid) and have participated in additional activities to accumulate 12 credits.

Application Fee is $200.00.

Documentation must be submitted electronically. Application fee must be paid at time of submission with credit card. The application fee is not refundable.

If there are any questions please contact [email protected]

Once the above documentation has been received, reviewed by the Oversight Committee (OC) and approved, the applicant will be notified of their application status. Final acceptance and level of Certification are at the discretion of the OC.

    If applicable
  • 2 credits/year with maximum of 8 credits
  • 0.5-2 credits/year, with max. of 4 credits at discretion of the OC
  • PROOF OF EARNED CREDITS

    As ONE PDF, please upload your supporting documents

    Without supporting documents, your application will be disqualified.

    The information that you will need to upload is as follows:

    1. Two letters of recommendation from your education institution
    2. Curriculum vitae
    3. Educators Portfolio
    4. A photo of yourself
    5. Additional documents to support educational activities

    Accepted file types: pdf.
  • Price: $200.00
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Contact the ASE

11300 W. Olympic Blvd
Suite 600
Los Angeles, CA 90064 USA
(310) 215-1226
[email protected]
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