Examination Eligibility Extension Request

Fill out the request form below to request an Extension of time up to 30 days.

First Name *

Last Name *

Phone *

Email *

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Select the exam(s) that you need an extension for: *

Basic ECG

12-Lead ECG

Advanced ECG

CVRN-BC Level I

CVRN-BC Level II

CVNP-BC or CVPA-BC

I confirm that I have not already scheduled my examination with a proctor and confirm I am making this request at least 10 days before the end of my original 180-day eligibility period. * *

I Confirm

State Your Reason for The Extension: *

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