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 *

I Consent to Receive SMS Notifications, Alerts & Occasional Communications regarding my Eligibility Extension Request from the American Board of Cardiovascular Medicine, LLC. Message frequency varies. Message & data rates may apply. Text HELP to 877-680-2226 for assistance. You can reply STOP to unsubscribe at any time.

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: *

Privacy Policy | Terms of Service