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RECERTIFICATION BY CONTINUING EDUCATION & CLINICAL PRACTICE HOURS

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Recert CE & CP App 10.12.2020 WWW.AANPCERT.ORG
1
American Academy of Nurse Practitioners Certification Board - Recertify by CE & Clinical Practice
RECERTIFICATION BY CONTINUING EDUCATION & CLINICAL PRACTICE HOURS
✓ Recertification requirements must be completed within the 5-year period of certification granted.
✓ Applicants are encouraged to complete their recertification application online at www.aanpcert.org
✓ Certification is not active past the expiration date. The ability to apply online is not available after a certification expires.
Application Information
• Use of a permanent email address is recommended and not a university or business email which may be temporary.
• This is a fillable PDF form and not an online application. Save the form on your computer first or print it as a paper application
before completing. A non-refundable paper application fee is charged for processing a paper application regardless of delivery
method (email, mail, fax) to AANPCB.
• Refer to the Recertification Handbook and Frequently Asked Questions online for additional information, policies, and procedures.
• Current, active professional nurse licensure in the United States, U.S. territories, or Canadian province or territory is required. Access
a copy of RN, NP, or APRN nursing license with expiration date from your state or government-appointed licensing board of nursing
online verification system.
• Print as many copies of the CE Log, Preceptorship Form, and Faculty Clinical Supervision Log as needed to complete application.
• Incomplete applications will result in processing delays. Complete the Application Checklist (p. 9) prior to submitting application.
• Email, mail, or fax application and supporting documents to AANPCB.
• All applications are subject to AANPCB Audit Policy. AANPCB reserves the right to request supporting documentation for validation
of preceptorship, faculty clinical supervision, or the provision of direct client care in the NP certification role and population-focus.
• Applicants are responsible for maintaining/updating their AANPCB Online Profile to receive program information from AANPCB.
Monitor your Online Profile for updates regarding application status and important messages.
Continuing Education Requirements (Effective January 1, 2017)
• 100 hours of advanced nursing practice continuing education (CE) applicable to the population focus, which includes a minimum of
25 advanced practice pharmacology credit. CE activities completed outside of the 5-year certification period will not be accepted.
• Basic Life Support (BLS) is not accepted.
• Refer to the Recertification Handbook for acceptable CE and advanced life support courses, CE tracker and accreditation
information.
Clinical Practice Requirements and Faculty Clinical Supervision Hours
• Minimum of 1,000 clinical practice hours as a nurse practitioner in the appropriate population-focus of certification. Hours must be
documented and verifiable.
• Faculty may claim a maximum of 500 on-site student clinical evaluation hours. The remaining 500 hours of the minimum 1,000 hours
must be direct patient care employee or volunteer clinical practice hours. Complete the separate Faculty Clinical Supervision Log
(found online under Forms).
Academic Coursework and Preceptorship Hours (Optional)
• Academic Coursework: Credit may be received for graduate or post-graduate courses taken if the coursework directly relates to
advanced practice nursing knowledge and skills. A university transcript with your name, university name, and the academic
coursework is required. One academic semester credit equals 15 CE contact hours. Courses are subject to approval and course
descriptions may be requested.
• Preceptorship Hours: A maximum of 120 clinical preceptorship hours conducted after January 1, 2017 may be claimed for a
maximum of 25 non-pharmacology CE credits. Complete the Preceptorship Form (found online under Forms). Convert hours and
enter on the CE Log. See Conversion Table in the Recertification Handbook.
American Academy of Nurse Practitioners Certification Board (AANPCB)
Email: Certification@aanpcert.org Main Number: (512) 637-0500 Toll-free Number: (855) 822-6727 Fax: (512) 637-0540
Mailing Address: P.O. Box 12926 Austin, TX 78711-2826 Overnight Delivery: 2600 Via Fortuna, Ste 240 Austin, TX 78746
Recert CE & CP App 10.12.2020 WWW.AANPCERT.ORG
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American Academy of Nurse Practitioners Certification Board - Recertify by CE & Clinical Practice
PLEASE AUTOFILL OR PRINT. Name on application will be the name printed on certificate and wallet
card. Month/day of birth and last 4 numbers of applicant’s Social Security number are unique identifiers
required to process an application.
1. CERTIFICANT INFORMATION
Name (First Middle Last)
Month/ Day of Birth
(mm/dd)
Last 4 SSN
Email
Country
City
State or Province
(USA & Canada only)
Zip/ Postal
Code
Primary Phone Number
Alternate Phone Number
I am applying to renew the following certification:
□ Adult Nurse Practitioner (ANP)
□ Adult-Gerontology Primary Care Nurse Practitioner (AGNP)
□ Emergency Specialty Nurse Practitioner (ENP) *
□ Family Nurse Practitioner (FNP)
□ Gerontologic Nurse Practitioner (GNP)
Certification Number #
(begins with A, AG, E, F, or G)
Certification Begin Date
(mm/dd/yy)
Certification End Date
(mm/dd/yy)
* Emergency Nurse Practitioners only: ENPs certified by AANPCB
are required to maintain current Family Nurse Practitioner certification.
Provide a copy of ANCC wall certificate or wallet card with FNP
certification number and expiration date if you are certified by ANCC.
FNP Certifier: □ AANPCB □ ANCC
FNP Certification: #
FNP Certification End Date (mm/dd/yy)
2. ATTESTATION STATEMENT FOR NP CERTIFICATION
Confirm by checking each statement, then sign and date. Applications are incomplete without a signature.
□ I accept the AANPCB policies that are available on the website and in the Recertification Handbook.
□ I attest that information provided on all pages of this application are true and correct. I understand that misstatement of material
fact may result in revocation of my certification and I am subject to AANPCB Disciplinary Policy and procedures.
I can attest that during my 5-year certification period:
□ I possessed a current active professional nursing license in a state/territory of the U.S. or Canadian province.
□ I met the minimum requirement for advanced practice continuing education applicable to my NP certification population-focus.
□ I worked a minimum of 1,000 clinical practice hours as an NP in the role and population focus.
□ I can provide further validation of my clinical practice, preceptorship, or faculty supervision hours (as applicable) if required.
NP Signature (Required):
Date:
Office Use
click to sign
signature
click to edit
Recert CE & CP App 10.12.2020 WWW.AANPCERT.ORG
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American Academy of Nurse Practitioners Certification Board - Recertify by CE & Clinical Practice
3. PROFESSIONAL NURSE LICENSURE
• Provide a copy of professional nurse licensure with current expiration date.
• Access a copy of RN, NP, or APRN nursing license with expiration date from your state or government-appointed licensing board of
nursing online verification system.
State/Territory
License #
Exp. Date
State/Territory
License #
Exp. Date
4. CONTINUING EDUCATION (CE) RECORD
• Continuing Education requirements must be completed within the 5-year period of certification. CE activities completed outside of the
5-year certification period will not be accepted.
• Complete the My CE Log.
• Provide copies of the CE certificates and trackers in the order listed on the log. CEs may be sent via email, mail, or fax.
• Refer to the Recertification Handbook and FAQs for information on acceptable CE, CE certificates and trackers, CE accreditation,
Preceptorship Hours and conversion table, academic coursework, and Faculty Clinical Site Visit information.
CE requirements
• 100 hours of advanced nursing practice continuing education (CE) applicable to the NP role and population focus is required.
• Advanced Practice Pharmacology (Rx) credit: A minimum of 25 of the 100 CE hours is required. Do not re-add these credits if the
pharmacology credit is included in the total CE contact hours.
• Advanced life support courses: Refer to the Recertification Handbook for a list of acceptable advanced life support courses.
Basic Life Support (BLS) is not accepted.
Optional Credit
• Optional Academic Credit: 1 academic credit hour = 15 contact hours. Submit transcript from university registrar.
• Optional Preceptorship credit: A maximum of 120-preceptor hours completed after 01/01/2017 may be claimed for conversion to a
maximum of 25 non-pharmacology CE credits. Complete the separate Preceptorship Form and submit with application.
Examples:
NAME OF CONTINUING EDUCATION ACTIVITY
SPONSOR/
INSTITUTION
CE
ACCREDITOR
(e.g., AANP,
ANCC, ACCME)
DATE
COMPLETED
(mm/dd/yy)
CE CONTACT
HOURS
AWARDED
Rx
CONTACT
HOURS
AWARDED
Example: UpToDate Tracker. The tracker lists a total of
30 AMA PRA Cat 1 Credits includes 15 prescribed hours
AANP
ACCME
04/10/2019 -
05/10/2020
30.0
15.0
Example: Anxiety during COVID-19: When to
Intervene
Pri-Med Institute
AANP
09/14/2020
1.0
0.33
Example: Utah NP 26
th
Annual Pharmacology Conf.
This program has been granted 13.25 contact hours of
AANP CE (which includes 12.42 pharmacology hours)
Utah Nurse
Practitioners
AANP
04/26/2019 –
04/27/2019
13.25
12.42
Example Academic Coursework: NSG 530 Advanced
Pathophysiology. 3 credits x 15 contact hours = 45
hours
Wilkes University
CCNE
05/31/2020
45.0
0
Example: Preceptorship. 120 hours = Maximum of 25
non-pharmacology contact hours
University of
Florida
CCNE
12/10/2019
25.0
n/a
Example:
CE Total:
114.25
Rx Total:
27.75
Recert CE & CP App 10.12.2020 WWW.AANPCERT.ORG
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American Academy of Nurse Practitioners Certification Board - Recertify by CE & Clinical Practice
My CE Log p. 1
Certificant Name
Last 4 of SSN
Certification Begin Date
Certification Expiration Date
• All CE must be completed within the 5-year period of certification.
• CE activities submitted that fall outside the 5-year period of certification granted will not be accepted.
• Basic Life Support (BLS) is not accepted.
NAME OF CONTINUING EDUCATION ACTIVITY
SPONSOR/
INSTITUTION
CE
ACCREDITOR
DATE
COMPLETED
(mm/dd/yy)
CE CONTACT
HOURS
AWARDED
Rx
CONTACT
HOURS
AWARDED
1 Preceptorship Hours: A max. of 120-preceptor
hours completed after 01/01/2017 may be claimed for
conversion to a max. of 25 non-pharmacology CE credit.
n/a
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Total CE Hours (this page):
Rx:
Recert CE & CP App 10.12.2020 WWW.AANPCERT.ORG
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American Academy of Nurse Practitioners Certification Board - Recertify by CE & Clinical Practice
My CE Log p. 2
Certificant Name
Last 4 of SSN
Certification Begin Date
Certification Expiration Date
• All CE must be completed within the 5-year period of certification.
• CE activities submitted that fall outside the 5-year period of certification granted will not be accepted.
• Basic Life Support (BLS) is not accepted.
NAME OF CONTINUING EDUCATION ACTIVITY
SPONSOR/
INSTITUTION
CE
ACCREDITOR
DATE
COMPLETED
(mm/dd/yy)
CE CONTACT
HOURS
AWARDED
Rx
CONTACT
HOURS
AWARDED
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Office use:
Total CE Hours (this page):
Rx:
Recert CE & CP App 10.12.2020 WWW.AANPCERT.ORG
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American Academy of Nurse Practitioners Certification Board - Recertify by CE & Clinical Practice
5. NP CLINICAL HOURS AND PRACTICE SITE RECORD
• Minimum of 1,000 clinical practice hours as a nurse practitioner in the appropriate population-focus of certification within the 5-year
period of certification.
• Providing advanced practice care of patient health conditions involving assessment, diagnosis, and treatment as an in-person
encounter or remotely via telehealth are considered direct patient care. Clinical practice hours worked as an NP in a volunteer
capacity for a national or international service organization is accepted. An official detailed description of duties may be requested.
Clinical Practice Site 1
Address
City/State/Zip
From (mm/yy)
To (mm/yy)
Number of Clock Hours
At this site, did you function as a Nurse Practitioner in the Advanced Practice Role in your Population Focus?
□ Yes
□ No
Clinical Practice Site 2
Address
City/State/Zip
From (mm/yy)
To (mm/yy)
Number of Clock Hours
At this site, did you function as a Nurse Practitioner in the Advanced Practice Role in your Population Focus?
□ Yes
□ No
Clinical Practice Site 3
Address
City/State/Zip
From (mm/yy)
To (mm/yy)
Number of Clock Hours
At this site, did you function as a Nurse Practitioner in the Advanced Practice Role in your Population Focus?
□ Yes
□ No
FACULTY CLINICAL SITE VISIT HOURS SUMMARY □ Not applicable
• Complete the separate Faculty Clinical Supervision Log (found online under Forms).
• Faculty may claim a maximum of 500 on-site student clinical evaluation hours completed within the 5-year period of certification.
Clinical Visit Dates
From (mm/yy)
To (mm/yy)
Total Number of Faculty Clinical Site Visit Hours within the 5-year period of certification:
At these site visits, did you supervise NP students engaging in patient management at a clinical site?
□ Yes
□ No
Recert CE & CP App 10.12.2020 WWW.AANPCERT.ORG
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American Academy of Nurse Practitioners Certification Board - Recertify by CE & Clinical Practice
6. CERTIFICATION FEE
□ AANP or AAENP Member $170.00 * □ Non- Member $245.00 *
* Includes a non-refundable paper application fee is charged for processing of a paper application. Fees are subject to change without notice.
Payment Information
□ Enclosed is my check/money order # _________________
Make payable to the American Academy of Nurse Practitioners Certification Board (AANPCB)
□ Charge my credit card
□ Visa
□ Master Card
□ Amex
□ Discover
Name on Credit Card (Please Print)
Card Number
Expiration Date
CVN
Signature
Billing Information
First Name
Last Name
Company Name
Street Address
City
State/Province
(USA & Canada only)
Zip/Postal Code
Primary Phone Number
Alternate Phone Number
Billing Email
7. MEMBERSHIP ORGANIZATION
• AANPCB is affiliated with two national membership organizations - the American Association of Nurse Practitioners (AANP) and
the American Academy of Emergency Nurse Practitioners (AAENP). Belonging to a Membership organization is not a
requirement.
• Members of the AANP and AAENP qualify for a $75 USD discount on all certification applications. Include member number when
completing the application to receive the discount. Membership numbers are different from the AANPCB certification number.
• For more information about the AANP and AAENP membership organizations and discounts, see FAQs - Affiliated Membership
Organizations and FAQs - Fees and Discounts on the certification website.
I belong to the following affiliate organization (if applicable)
□
American Association of Nurse Practitioners
Membership #
□
American Academy of Emergency Nurse Practitioners
Membership #
Recert CE & CP App 10.12.2020 WWW.AANPCERT.ORG
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American Academy of Nurse Practitioners Certification Board - Recertify by CE & Clinical Practice
8. STATE BOARD OF NURSING NOTIFICATION ORDER FORM
DO NOT USE THIS FORM FOR 3
RD
PARTY CREDENTIAL PRIMARY SOURCE VERIFICATION
• Complete this form if you would like your State Board of Nursing to be notified of your certification status. Please print clearly.
• Fee: $0. AANPCB does not charge a fee to send certification status to State Boards of Nursing.
• This is a fillable PDF form. Download and save to your computer or print. Complete and submit via email, fax, or mail.
• Questions about the SBON Notification Order Form? Contact the Verification Dept. at (512) 637-0500.
Candidate Information
Name
(First Middle Last)
DOB (mm/dd)
Last 4 SSN
Address
City State Zip
Notify the following State Board(s) of Nursing
State Board of Nursing
Comment:
State Board of Nursing
Comment:
Notify the SBON(s) listed above of my Nurse Practitioner Certification Status
□
I am applying to renew my AANPCB certification.
I approve release of my certification status to the
above SBON after my recertification application is
processed. (check which NP certification)
□
Adult Nurse Practitioner (ANP)
Certification: A #
□
Adult-Gerontology Primary Care Nurse Practitioner (AGNP)
Certification: A-G #
□
Emergency Nurse Practitioner (ENP)
Certification: E #
□
I have been certified as a Nurse Practitioner by
AANPCB and would like AANPCB to notify the SBON
of my certification status. (check which NP certification)
□
Family Nurse Practitioner (FNP)
Certification: F #
□
Gerontologic Nurse Practitioner (GNP)
Certification: G #
NP Signature (Required)
Date
click to sign
signature
click to edit
Recert CE & CP App 10.12.2020 WWW.AANPCERT.ORG
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American Academy of Nurse Practitioners Certification Board - Recertify by CE & Clinical Practice
9. APPLICATION CHECKLIST
□ Application form is completed, signed, & dated.
□ Name on application is the legal name used for certification purposes and will be the name printed on certificate and wallet card.
□ Fee payment is required to process an application. Check attached, or credit card information completed.
□ Email, mail, or fax a copy of current nursing license with expiration date.
□ License number on the copy sent and matches the license number entered on application.
□ State Board of Nursing Notification Order Form is completed.
□ CE Record is complete with the minimum required number of advanced nursing practice and advanced practice pharmacology.
□ CE certificates show applicant name, activity title, date, accreditor, sponsor, and CEs awarded for completion of the course.
Email, mail, or fax copies of the CE certificates and trackers in the order listed on the CE log(s).
□ Basic Life Support (BLS) is not accepted.
□ Clinical Practice site information is complete. Hours worked within the past 5 years total a minimum of 1,000 hours.
□ Email, mail, or fax supporting documents to AANPCB.
□ For Advanced Life Support Coursework: A CE certificate showing your name, activity title, date, accreditor, sponsor, and CEs
awarded for completion of the course is required. A wallet card will not suffice.
□ For Faculty Clinical Supervision: Complete and submit log with dates of clinical agency visits, dates, and number of clinical
supervision hours.
□ For Preceptorship Hours: Complete and submit Preceptorship Form. Hours claimed do not exceed 25 non-pharmacology CE
credits.
□ For Academic Coursework: A transcript with the name(s) of the NP certificant and university, course information, completion date,
and passing grade is required.
□ For ENP renewal: Provide a copy of the Family Nurse Practitioner certification wallet card or certificate with expiration date if
certified as an FNP by the American Nurses Credentialing Center (ANCC).
Notes:
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RECERTIFICATION BY CONTINUING EDUCATION & CLINICAL PRACTICE HOURS

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Completed 10 May 2021

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