Academy Board of Trustees Nomination Application

Thank you for your interest in applying for service on the 2025 Academy Board of Trustees. At any time, you may click the Save & Continue Later link at the bottom of the screen. This will save the information you have entered and allow you to log back in to complete your form at a later date.

All applications will be reviewed by the Academy Nominating Committee, and a slate of recommended candidates will be put forward to the Academy Board for approval. Academy certificants will vote on the Board-approved slate in October. All nominees will be contacted in November and provided a status of their application.

Questions? Email Steven Gonzalez, Associate Director of Certification at steven.gonzalez@acrpnet.org.

APPLICATION DEADLINE: JUNE 30, 2024

Candidate Information

Name*

First Middle Initial (optional) Last Suffix/Certifications

Email*

Enter Email Confirm Email

Preferred Phone*

Address*

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

Company/Organization*

Job Title*

Are you at least 21 years of age?*

Yes
No

Have you ever served on the ACRP or Academy Board of Trustees?*

Yes
No

If yes, when?

How many years of experience do you have in clinical research?*

Less than one year
1-4 years
5-10 years
11-15 years
16-20 years
More than 20 years

Are you an Academy certificant in good standing?*

Yes
No

Which of the ACRP certifications do you have? Check all that apply.*

ACRP-CP
ACRP-PM
CCRA
ACRP-MDP
CCRC
CPI
FACRP (Fellow)
None of these

Which of the following applies to you? Check all that apply.

Served for at least two years as a member of an Academy Exam Committee
Submitted test questions as an Item Writer
Participated in a test development capacity (standard setting, job analysis)

Which setting listed best describes your current work situation?*

If Other, please specify.

In which setting have you worked in the past? Check all that apply.*

If Other, please specify.

Academy Board of Trustees Nomination Application

Academy Board Of Trustees Nomination Application

Step 1 of 5

Candidate Information

Volunteer/Leadership Roles

Nomination Questions

Biographical Information

Disclaimer and Consent