APACS Recertification Application - The Association for Surgical Education

Contact Information

Name(Required)

First Last

Email(Required)

Institution(Required)

Institution Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Please confirm the following:(Required)

You must meet all of the below criteria to eligible for recertification.

I am an ASE member in good standing

I have three consecutive years of experience in undergraduate surgical education administration since certification or last recertification

I have served for at least 1 year as an active member and/or chair of an ASE Coordinator Sub-Committee

I have presented at least 1 best practice presentation during annual ASE Coordinator Track Program

Supporting Documents

CV(Required)

Accepted file types: pdf, Max. file size: 512 MB.

Reflective essay(Required)

Please upload a one-page reflective essay about an experience demonstrating continued professional growth.

Accepted file types: pdf, Max. file size: 512 MB.

Powerpoint Presentation(Required)

Best practice presentation(s) during annual ASE Coordinator Track Program

Drop files here or

Accepted file types: pdf, Max. file size: 512 MB.

Credits

Years served as a Clerkship Coordinator(Required)

2 credits earned per year as Clerkship Coordinator, 6 credits maximum. List each year as a Clerkship Coordinator, and click the + button to add years.

1 credit for each presentation given during the annual ASE Coordinator Program Track(Required)

1 credit per presentation (at least one presentation required). Please list year and title of the presentation. Click the + button to add year and presentation.

Please select any of the following which you have completed:

1 credit each

ASE Coordinator Executive Committee Member

ASE Coordinator Sub-Committee Chair

Held a leadership role on a committee within coordinator’s institution

Accepted abstracts for Poster or Paper Presentation

Published Educational Research Articles

Years attended Coordinator Track Program Annual Meeting

1 credit per year attended, maximum of 3 credits. Click the + button to add years.

Departmental, institutional, or non-ASE national presentation(s)

1 credit per presentation, maximum of 3 credits. Click the + button to add presentations.

Professional development: attend qualifying workshops or seminars

1 credit per activity, maximum of 3 credits. Click the + button to add activities.

Please select any of the following which you have completed

0.5 credits each

Active participation in a clerkship coordinator sub-committee

Active participation in the clerkship coordinator Mentoring Program as Mentor or Mentee

Facilitating a Hot Topic, Round Table or Panel discussion at ASE Coordinator Program Track

Participate as an active member of a committee within a coordinator’s institution

Professional development: online learning modules, webcasts, etc.

ASE Clerkship Coordinator Recognition Award or other awards related to the coordinator’s role

Participation in a LCME site visit or internal review

Have given a presentation during a monthly virtual meeting (0.5 credit per presentation, max of 4 presentations/2 credits)

Payment Information

APACS Recertification Fee(Required)

Price:

Total

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Card(Required)

American Express

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Card Number

Expiration Date

Security Code Cardholder Name

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