Pediatric Radiology Subspecialty Application

Pediatric Radiology Subspecialty Application
Application & Exam Fees
- If you were previously approved by the ABR or the Pediatric Radiology exam, please contact the office at 520-790-2900 for instructions. This application is only for first-time applicants.
- Within 10-14 business days after submitting your application, you will receive an email from ABR staff notifying you that your application has been received, and instructions on paying the $640 application fee via myABR.
- Once the application fee has been paid, your application will be processed and reviewed.
- If your application is approved, you will receive an email notifying you of the approval, and instructions on paying the $1280 exam fees via myABR. The exam fee must be paid in order to register for the exam.
- If your application is not approved, you will receive an email outlining the reason your application was not accepted. You would then re-apply in the future when you meet the application requirements.
More information is available on the ABR website:
- Requirements and Registration
- Dates, Locations and Fees
Before you begin this form

You must have the following documents scanned and saved to your computer, as you will need to attach these within the application. You cannot save the application and return to it later:

If applying via the Standard/Fellowship Pathway:
Requires one year of fellowship training (after residency) in a pediatric radiology program accredited by the ACGME or by the RCPSC (Canada).
- A copy of your fellowship certificate or an official letter (on letterhead) signed by your program director, documenting your ACGME-accredited pediatric radiology fellowship training, including dates.
If applying via the Alternate/Practice Pathway:
Requires service on the pediatric radiology subspecialty faculty at a single institution for:

Two consecutive years at 1.0 FTE, with at least 75 percent of clinical responsibility in the discipline,
or
Three consecutive years at 1.0 FTE, with at least 50 percent of clinical responsibility in the discipline.
- An official letter (on letterhead) signed by your chief of service or department chair documenting your faculty experience. The letter must state that you are employed 1.0 FTE, with dates and percentage of time spent in pediatric radiology
Name*

First NameMiddle NameLast Name
ABR ID*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
When did you receive your primary radiology certification?*
Month/Year
My name at the time of this certification was:*

The sameDifferent
If different, what was your name?

Please indicate the pathway under which you are applying.*

Standard PathwayAlternate/Practice Pathway

Fellowship Program (Standard Pathway Only)
Institution *
City and State*
Began*

MonthDayYear
Date
Completed*

MonthDayYear
Date
Please list contact information for the program director of your pediatric radiology fellowship:
Name*

First NameLast Name
Email*
example@example.com
Submit a copy of your fellowship certificate or one official letter (on letterhead) from your program director, documenting your ACGME-accredited pediatric radiology fellowship training, including dates.*

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Standard Alternate/Practice Pathway
Institution *
City and State*
Please list contact information for the Chief of Serivce or Chair of your department:
Name*

First NameLast Name
Email*
example@example.com

Faculty Member Experience*

	Institution	City/State	Average hours per week or percentage of time in pediatric radiology	From	To
A

Submit one original letter (on letterhead) from your chief of service department chair, with dates documenting your faculty experience and percentage of time spent in pediatric radiology. *

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Application Submission
To submit your application, please click the "Submit Application" button below.
Should be Empty:

Pediatric Radiology Subspecialty Application

Fellowship Program (Standard Pathway Only)

Standard Alternate/Practice Pathway

Application Submission