Certification Application

For downloadable/printable Application Form - Click Here

Name*
First Middle Last
Professional Credentials (e.g MD, PhD, RN)*
Title/Position*
Specialty*
Department*
Facility Name*
Facility Street Location Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing Address if different
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Professional Information
Business Line*
Direct Line*
Business Fax
Direct Fax
Website
Business Email*
Personal Information:
In case of a job change, so we can reach you regarding your certification.
Home Street Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Personal E-mail*
Cell Phone*
Specialty
Primary Clinical Credentials*
Provide Your Primary Clinical Credential
- Physician
- Physician’s Assistant
- Nurse Practitioner
- Advanced Practice Nurse
- Other (Describe)
Other Credential*
Secondary Clinical Credentials*
- None
- Physician
- Physician’s Assistant
- PhD
- Master’s Degree
- Nurse (all categories)
- Other (Describe)
Secondary Clinical Credentials*
Medical Specialty Certifications*
- Medical Oncology
- Radiation Oncology
- Surgery
- OB/GYN
- Internal Medicine
- Nursing Specialty Certifications (Describe)
- Other (Describe)
Medical Specialty Certifications Nursing*
Medical Specialty Certifications Other*
Practice Focus*
- Oncology
- Surgery
- Gynecology
- Primary Care
- Other (Describe)
Practice Focus
Training/Educational Activities in Cancer Genetics and Risk Assessment*
- Conference
- Courses
- Web-based tutorials
- Practice based learning
- Other (Describe)
Training/Educational Activities in Cancer Genetics and Risk Assessment*
Practice Environment (work related experience) in Cancer Genetics and Risk Assessment*
- High Risk Clinic – hospital based
- High Risk Clinic – outpatient setting
- Cancer Clinic
- Comprehensive Breast Center
- Other (Describe)
Practice Environment (work related experience) in Cancer Genetics and Risk Assessment*
Years of work-related experience in Cancer Genetics and Risk Assessment*
- 2 years
- 2-5 years
- 5-10 years
- 10-15 years
- 15-20+ years
- Other (Describe)
Years of work-related experience in Cancer Genetics and Risk Assessment*
Certification Exam Purpose

To assess knowledge, skills and competencies previously acquired and necessary to assess, educate and provide cancer risk assessment and cancer genetics clinical services to patients and their families. There is a focus of this exam on comprehensive breast cancer risk assessment although a broader recognition of cancer genetics and cancer predisposition genes associated with hereditary cancer risk is expected of the candidate.

Target Audience

Preferred candidates are licensed professionals, including physicians, nurse practitioners/advanced practice nurses and physician assistants seeking to demonstrate advanced knowledge in providing cancer genetics and cancer risk assessment subspecialty practice. Genetic counselors do not need to obtain this certification as the competencies are covered by genetic counselor training and maintenance of certification.

NCBC recognizes that there may be other licensed or certified skilled practitioners who possess the requisite educational background, work-related knowledge, competency and clinical experience to be considered eligible to apply for certification in CGRA. Inquiries should be forwarded to the program director and will be assessed on a case by case basis by the certification board to assure that eligibility for this certification is met before sitting for the CGRA examination.

CGRA Certification Eligibility Requirements

In order for an individual to be eligible to apply to take the Cancer Genetics Risk Assessment (CGRA) Certification Exam and to receive certification eligibility notification, a candidate must meet all of the following requirements:
1. Licensure:
  
  Comply with all state requirements for current and unrestricted licensure as a registered healthcare professional - physician, registered nurse, advanced practice nurse, physician assistant.
1. Education:
  
  Complete a minimum of 60 hours of relevant education, training activities in cancer genetics and cancer risk assessment.
1. Experience:
  
  Complete minimum of two years of clinical practice experience in the field of cancer genetics, cancer risk assessment.
1. Register:
  
  Pay the testing fee of $495 and register at www.Breastcare.org
1. Exam:
  
  Pass the CGRA exam.
NCBC conducts the certification program independently of any specific class, course or other education/training program and is also independent of any provider of classes, course or programs. The assessment is not designed to evaluate mastery of the intended learning outcomes of a specific class, course or program, nor is NCBC, as the certification program provider, the sole provider of any education or training that may be required for certification. NCBC's certification program is also not responsible for accreditation of educational or training programs or courses of study leading to the certification.

There are multiple pathways and educational resources by which a candidate could acquire the requisite specific areas of knowledge for competency as a healthcare provider in cancer genetics and risk assessment. Resources may include self-study, practice-based education, online course/web-based study, review of professional journals or in-person courses for healthcare providers in cancer genetics and cancer risk assessment.

Certification Process

All candidates, regardless of professional licensure or certification, are required to take an exam assessing knowledge, skills and competencies required for CGRA Certification. The exam consists of 120 questions and is conducted in a secure, proctored environment with a 3 hour time limit. Successful completion of the assessment exam is required to receive the certification. The exam consists of 100 scored questions and 20 unscored questions.

Certification Annual Renewal

The Cancer Genetics Risk Assessment Certification requires annual renewal with eight (8) continuing education credits in cancer genetics, risk assessment content earned per year. A failure to renew will result in inactive certification after 60 days past expiration and decertification after 1 year past expiration.

The annual renewal fee will cost $150

The online renewal form can be found at www.CGRAcertification.org

Certification Application

Professional Information

Personal Information:

Specialty

Certification Exam Purpose

Target Audience

CGRA Certification Eligibility Requirements

Certification Process

Certification Annual Renewal

CGRA® Certification