Application for ACHCA Certification Exam Item Writer

							                        Certification Exam Item Writer Application

DATE OF APPLICATION_________________________          ACHCA MEMBER #________________________

NAME_____________________________________________________________________________________

TITLE_____________________________________________________________________________________

FACILITY__________________________________________________________________________________

BUSINESS ADDRESS__________________________________________________________________________

CITY___________________________________________       STATE____________    ZIP________________

HOME ADDRESS_____________________________________________________________________________

CITY__________________________________________        STATE____________     ZIP________________

DAYTIME PHONE________________________________         FAX_____________________________________

EVENING PHONE________________________________         EMAIL___________________________________

PLEASE SPECIFY WHICH ADDRESS ACHCA SHOULD USE:           BUSINESS          HOME
1. CURRENT ACHCA CREDENTIALS (CHECK ALL THAT APPLY AND INDICATE EXPIRATION DATE FOR EACH):
 CNHA          CALA         CAS           Other___________________________________________
2. AREAS OF EXPERTISE IN WHICH YOU ARE QUALIFIED TO WRITE QUESTIONS (CHECK ALL THAT APPLY):
GENERAL ADMINISTRATION
 Food Service
 Client Service
 Clinical Services
 Personnel/HR
Environmental Management
 PR and Marketing
 Financial Management                     
 Organizational Management / Governance

NURSING HOME ADMINISTRATION
 Client Services
 Clinical Services
 Environmental Services
 Financial Management
 Organizational Management / Governance

ASSISTED LIVING ADMINISTRATION
 Client Services
 Clinical Services
 Environmental Services
 Financial Management
 Organizational Management / Governance




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3. PLEASE STATE WHY YOU WOULD LIKE TO SERVE AS AN ACHCA CERTIFICATION EXAM ITEM WRITER:




4. PLEASE ATTACH COPY OF RESUME OR VITAE


                                           Item Writer Description
ELIGIBILITY REQUIREMENTS
 Must be a volunteer
 ACHCA Certification is required (unless the applicant is from an academic or related field and is not eligible to
   take the exam).

TERMS AND CONDITIONS
 Item Writers typically serve for three-years. ACHCA staff and the Professional Advancement Committee will
   select Item Writers to ensure adequate representation for each content area of the exam.
 Item Writers can be either writers or subject matter experts or, preferably, both.

RESPONSIBILITIES AND DUTIES
 Item Writers must sign a confidentiality and copyright statement.
 Item Writers must attend an ACHCA-sponsored training and orientation workshop.
 Item Writers must submit a minimum number of items of good quality each year (Exact number to be
   determined. Most item writers submit between 15-45 items per year).

DISQUALIFICATION
 Item Writers will be dismissed for failure to meet deadlines and/or submission of poor quality items. Writers
    will also be dismissed for breach of confidentiality (you will be asked to sign a confidentiality statement).

RECERTIFICATION
 Item Writers, who serve for 3 of the 5 years of their certification period, have their recertification fee waived.
    However, they still must submit their recertification form and document their CE during their certification
    period.
Notes
 Item Writers may not take an ACHCA certification exam while serving as an item writer or for a three-year
    period following their last item writing assignment. Item Writers cannot become ACHCA certified via item
    writing.

   All policies are subject to change by the Professional Advancement Committee.

   Item Writers earn CEUs for their participation in an ACHCA certification exam item writing workshop.


The ACHCA staff and Professional Advancement Committee will review your application and notify you of your
status. Please email this application and your resume/vitae to: jspence@achca.org. Thank you!



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