IRB MANAGER RECERTIFICATION BY EXAM APPLICATION SUBMISSION REQUIREMENTS: Complete this application Complete payment of $300 Recertification by Exam fee Year of Initial Certification(Required) Certificate Status(Required) Current Expired Name(Required) First Middle Last Applicant Personal Contact InformationHome Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta 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FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Personal Phone Number(Required)Personal Email Address(Required) Applicant Business Contact InformationJob Title(Required) Department(Required) Name of Organization Business Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Business Phone(Required)Extension (if applicable) Business Email Address(Required) Preferred Contact(Required) Business Email Personal Email Education InformationHighest Degree Earned(Required) Associate Degree Bachelor’s Degree Master’s Degree Technical School Certificate Program Other Specify Program:(Required) Current Employer(Required) Academic Medical Center Clinic Non-Academic Medical Center Free-Standing Research Facility Community Hospital VA or Military Medical Center Cancer Center Independent IRB Other IRB ExperienceAre you currently employed by an IRB?(Required) Yes No Indicate the percentage of time you work in IRB related activities(Required) Indicate your total number of years if IRB experience:(Required) 2 years 3 – 5 years 6 – 10 years More than 10 years IRB Management ExperienceIndicate your total number of years if IRB Management experience:(Required) 2 years 3 – 5 years 6 – 10 years More than 10 years Indicate the number of employees you supervise(Required) Indicate the number of research studies you are responsible for(Required) Types of IRB ReviewIndicate the type of research studies your IRB reviews Biomedical Behavioral/Social Other Please specify(Required) Membership in Professional OrganizationsAre you a member of any professional organizations? ACRP NAIL PRIMR RAPS SOCRA Other Please specify(Required) Other CertificationsDo you have any other certification(s) in human subjects protection programs? ACRP PRIMR RAPS SOCRA Other ResumePlease upload your current resume(Required)Max. file size: 4 MB.User Account Creation for ExaminationUsername(Required) You will use this and your password upon approval to login and complete your exam.Password(Required) Enter Password Confirm Password Applicant Agreement / AssuranceConsent(Required) I certify that the information provided in this recertification application is true, correct and complete.(Required)Consent(Required) I certify that I meet the eligibility requirements for recertification as a certified IRB Manager.(Required)Consent(Required) I certify that I am applying to take the IRB Manager Examination(Required)Signature10/04/2025Exam Fee Price: PLEASE NOTE: The processing fee associated with your PayPal payment is non-refundable. If your application is not approved, you will receive a refund less the processing feePayment Method*PayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Δ
