Step 1 of 2 50% This field is hidden when viewing the formlinkExam Date*19 April – 3 May 202519 July – 2 August 202525 October – 8 November 2025Candidate InformationName*Please enter your legal name that appears on your government-issued ID. First Last Address* 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 Profession*NursePharmacistEmail*This email address will be used to send all communications regarding your certification - scheduling email, pass/fail details, and all recertification information. Phone*Job Title*Are you currently an IgCN®/IgCP®?* Yes No What is your certification number?If you do not know your number, please email us at Info@ig-ns.org after the application is completed.Employer's InformationCompany NameSupervisor's Name First Last Supervisor's Email Supervisor's Phone Number Candidate DemographicsDo you need test accommodations?* Yes No How many years of practice in Ig therapy to you have?*Less than 2 years2 to 5 years6 to 10 yearsMore than 10 yearsHow many hours will you have at the selected testing window?*Please enter a number from 1 to 2000.What is your main site of practice today?*Inpatient / HospitalOutpatient (Infusion suite / Clinic / Other)Specialty pharmacy / Specialty infusionOtherWhat percentage of your practice involves pediatric patients?*None25%50%75-100%What percentage of your practice involves adult patients?*None25%50%75-100%What percentage of your practice involves immunology patients?*None25%50%75-100%What percentage of your practice involves neurology patients?*None25%50%75-100%What percentage of your practice involves hematology/oncology patients?*None25%50%75-100%What percentage of your practice involves rheumatology?*None25%50%75-100%What percentage of your practice involves subcutaneous Ig (SCIg)?*None25%50%75-100%What percentage of your practice involves intravenous Ig (IVIg)?*None25%50%75-100%This field is hidden when viewing the formAre you a scholarship winner?* Yes No Is this your first time taking the exam? Yes No This field is hidden when viewing the formSelect the year you received your scholarship 2020 2019 2018 2017 2016 2015 This field is hidden when viewing the formSelect the year you received your scholarship 2021 This field is hidden when viewing the formScholarship Year
