CCRP Exam Application

CCRP Exam application

To apply to take the exam, complete and submit the form below.
CCRP Exam Application Policies / Information:
- Once accepted, you will have one year from the date of acceptance to schedule your exam.
- Fees include complimentary membership in SOCRA, upon successful completion of the CCRP® exam.
- If for any reason this examination cannot be held, SOCRA is not responsible for costs incurred by attendees, such as airfares, or hotel or other reservations.
  SOCRA is an educational non-profit membership organization (corporation) - Federal Tax ID #61 1208981; however, your dues are not tax-deductible as a charitable contribution.
- For qualified applicants who apply for an examination, the fee is nonrefundable. The fee is refundable if the application process is unsuccessful.
Name (Please enter your name as listed on your government ID)

First NameMiddle NameLast NameSuffix
Name Prefix:

Other
Degrees:
Certifications:
Title:
Company/Affiliation:
Address type:
Address (where your certificate will be mailed):

Street Address

Street Address Line 2

CityState

Zip CodeCountry
E-mail
Note: This email address will be used for member emails and access to the Chapter Circle community. Personal email address is recommended.)
Phone type:
Phone Number
Format: (000) 000-0000.
If a current Member, enter Member ID:
Do you require ADA Accommodations to take the exam?
If Yes, please describe (supporting documentation must be included in application portfolio)
Type a question
Attach your COMPLETE application portfolio in ONE PDF file

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Once certified, you will be automatically included in SOCRA's online directory of CCRP certified clinical research professionals.
OPT OUT of being included in the directory:

Application Type

Member Fee Payment in Full

$510.00

Non-Member Fee Payment in Full

$560.00

Enter coupon

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

By submitting this application and portfolio, I attest that the information provided is accurate and understand that falsification or misrepresentation of my application information will invalidate my certification status, and I agree to the policies and procedures in the Candidate Handbook.
Attest and Agree:
Should be Empty:

CCRP Exam application

CCRP Exam Application Policies / Information:

Application Type*

Application Type