ACBR Part I Examination Application 2025

Application Due Date: 31 January 2025


Legal First Name Legal Last Name Date of Birth (MM/DD/YYYY) Home Address Phone Number Preferred Email Part I exam results will be mailed to the home address provided above. Part I exam results can also be delivered via email to the email address you provided above. Indicate your preference below. Select your preferred testing location: List the name of the chiropractic college attended. List the years attended at this institution. List chiropractic college graduation date (month, year) If more than one chiropractic institution was attended, please include the name of the college and years attended. List the name of the chiropractic college sponsoring your radiology residency. If the institution has multiple campuses, please specify campus location. List the start date of radiology residency (month, year). List the anticipated graduation date of radiology residency (month, year). Upload verification of residency contract or employment from your institution HR department (see Candidate Guide for details). If additional training in radiology was obtained, specify the type of training and location. Include the country and state (if applicable) of current and active DC license/registration. Upload a copy of current and active DC license/registration (PDF or JPEG). Identify the status of current DC license/registration. If your license/registration has ever been on probation or you have faced any disciplinary action, list in detail below. If there is no restriction to disclose, state "none". (Optional, leave blank if not applicable) If candidate maintains more than one active DC license/registration, list the country and state (if applicable) of additional license/registration. (Optional) Upload a copy of current and active second DC license/registration (PDF or JPEG). (Optional) Identify the status of second DC license/registration (Optional) If candidate maintains more than one active DC license/registration, list the country and state (if applicable) of additional license/registration. (Optional) Upload a copy of current and active third DC license/registration (PDF or JPEG). (Optional) Identify the status of third DC license/registration Have you ever been party to a malpractice lawsuit? If yes, list charge, dates, and outcome of the lawsuit. 2025_Application_Form_-_Misconduct_Agreement.pdf Download, review, and sign the Examination Misconduct Form. Upload the signed PDF. Upload a written letter of recommendation by your current residency director including all elements required (as published in the Candidate Guide). Select the number of times you have taken the ACBR Part I Board exam. I certify that I am in my third or final year of my postgraduate residency. I have read and understand all information contained in the Candidate Guide. I agree to abide by all rules and regulations set forth by the ACBR. I understand that failure to accurately and properly complete all the requirements of this process may invalidate my application. I hereby testify that all foregoing information is accurate according to my knowledge.

Exam Fee
	Part I Exam Fee more To pay electronically, please proceed to the next page to pay via PayPal. If you prefer to pay by check or money order, please mail to: ACBR Treasurer P.O. Box 2291 Davenport, IA 52809	$1,200.00

ACBR Part I Examination Application 2025

American Chiropractic Board of Radiology © 2024