American Association of Clinical Auditors and Coders

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Please make payment payable to: AACCA

AACCA National Certification Office
123 E. 9th Street, Suite #302
Upland, CA 91786

American Association of Clinical Coder & Auditors Certification Examination Application

Please note: Unless otherwise stated, all information must be completed on your certification exam application form for your application to be considered.

Please allow the AACCA 10 business days to process your Certification Application. You will receive 2 documents from the AACCA: (1) Notice of Eligibility and
(2) Authorization to Test. The Authorization to Test Letter will contain a serial number. Be sure to make a copy of the Authorization to Test letter, since you will have to submit the original to the Pearson Testing Center of your choice.

AACCA Membership History:

Current membership in the AACCA: _____ yes _____no

Please note: You must be a current member of the AACCA before applying for any certification(s) with our organizations. If you need to establish membership, please go to our member information to learn more.

AACCA Candidate Declaration:

Your certification examination application will not be considered unless you read, sign and include with payment our "candidate declaration". This declaration may be printed out and signed by clicking here.

Please contact our national office with any questions regarding the Pearson testing and certification process at certification@aacca.net.

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Full Name:________________________________

Street Address:______________________________________________________

City:____________________ State:________________ Zip:__________

Day Phone:(_____)___________________

Evening Phone:(______)_______________________ (optional)

Email Address:____________________________ (very important - please print)

Employer Name and City/Sate Location:___________________________________________

Current Job Title:_____________________________________

Clinical Education Level:____________________________________________

School(s) Attended:____________________________________________________________

Degree(s) Awarded:____________________________________________________________

Credential(s):__________________________________________________________________

_____________________________________________________________________________

License Type: _______________State: ______________ License Number:_______________

Additional Licenses (optional):

License Type: _______________State: ______________ License Number:_______________

Do you have any ADA-related special needs? (Optional: please check all that apply)

____Wheelchair Access ____Lower Chair ____Lower Table ____Special Interpreter

____Special Keyboard ____Other (please explain)

Name on formal certificate will appear as printed printed below.

Printed Name:______________________________________

Your Signature:_____________________________________

Today's Date:______________________

Enclosed is my check/money order Payable to AACCA for:

_________ $349 for the RN-Coder/Certified Clinical Coder Certification Exam.

________ $349 for the RN Auditor/Certified Clinical Auditor Certification Exam.

The AACCA does not discriminate based on age, race, sex, religion, national origin, disability or marital status. The AACCA is a non-profit educational and professional membership organization.