Apply & Renew | Research Nursing Certification

Clinical Research Nurse Certification Application

Application Type:

Initial Application

Initial Resubmission Application

Renewal Application

Full Name

Phone

Email

Mailing Address

It is the responsibility of the individual CRN to notify the Clinical Research Nurse Certification Council (CRNCC) of change in their name and/or address. CRNCC is not responsible for notices that fail to reach the Clinical Research Nurse (CRN).

*Enter Retired if Applicable for RN license or country equivalent

I attest to having an unencumbered RN license or country equivalent

Yes

No

State of Licensure

License Number

Select one of the following:

Application for Initial Certification: I attest to having at least 2 years minimum as an RN at time of initial application for certification and a minimum 4000 practice hours in the clinical research nurse role (not including hours in residency or orientation) in the previous 3 years at time of application for certification.

Application for Renewal of Certification: I attest to having at least 4000 practice hours in the clinical research nurse role (not including hours in residency or orientation) in the previous 5 years at time of application for renewal of certification.

My name may be published as having earned Clinical Research Nurse Certification

Yes

No

IACRN membership status: (choose one)

I am a current IACRN member.

I am NOT a current IACRN member.

Current Employer, Retired, or N/A

Role (e.g., study coordination, nurse scientist, protocol development, CRN supervisor, retired or N/A)

Title (Institutional name for position e.g., Nurse Clinician II, Nurse Manager, Retired or N/A)

Number of years as a nurse

Number of years practicing in clinical research

My submission affirms that all information submitted for the purpose of certification or recertification consideration is accurate and complete. It is my understanding that certification and recertification is based solely on the submitted materials and will be denied for any of the following reasons:

Falsification of application; Misrepresentation; Failure to meet criteria for contact hours/points per policy; Failure to provide requested information/documentation requested during audit; Failure to meet experiential requirement; Lack of current unencumbered RN license; Failure to submit appropriate fees; Failure to apply by deadline.

Upload your supporting documentation:

Please note underlined items below are live links to the document template should you need to download for submission.

Continuing Education Documentation Record *excel sheet

Continuing Education Certificates *ensure you include ALL certificates with submission.

Professional Activity Documentation Record *

Resume (Not required for renewal) *see Appendix E of Handbook

Exemplar (Not required for renewal) *see section 3.4 and Appendix F of Handbook

If applicable, include:

CRN Preceptor Form
CRN Mentorship Form
Supporting Documentation

Select File

All fees are non-refundable and non-transferable.

Verify Certification

Clinical Research Nurse Certification Application

Upload your supporting documentation:

Please note underlined items below are live links to the document template should you need to download for submission.

Continuing Education Documentation Record *excel sheet

Continuing Education Certificates *ensure you include ALL certificates with submission.

Professional Activity Documentation Record *

Resume (Not required for renewal) *see Appendix E of Handbook

Exemplar (Not required for renewal) *see section 3.4 and Appendix F of Handbook

If applicable, include:

CRN Preceptor Form

CRN Mentorship Form

Supporting Documentation

Contact Us

Verify Certification

Clinical Research Nurse Certification Application

Upload your supporting documentation: Please note underlined items below are live links to the document template should you need to download for submission.

Continuing Education Documentation Record *excel sheet

​

Continuing Education Certificates *ensure you include ALL certificates with submission.

​

Professional Activity Documentation Record *

​

Resume (Not required for renewal) *see Appendix E of Handbook

​

Exemplar (Not required for renewal) *see section 3.4 and Appendix F of Handbook

If applicable, include:

CRN Preceptor Form

CRN Mentorship Form

​Supporting Documentation

Contact Us

Upload your supporting documentation:

Please note underlined items below are live links to the document template should you need to download for submission.

Supporting Documentation