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Certification Application Form

Personal
First Name: *
Middle Name:
Last Name: *
Address: *
Address Line 2:
City: *
Province/State: *
Country: *
Postal/Zip Code: *
Phone: *
Fax:
Email: *
Gender: *
Date of Birth: *
Education
Name of Institution: *
Location: *
Program Name: *
Date in Attendance: to
Are you presently a student: *
In which city would you like to write the CAGC Certification Exam?: *
Do you require any special accommodations when writing the examination?: *
Application Type: *
Graduates from an ABGC or ACGC Accredited Program. The training program must have been ABGC/ACGC accredited for the entire duration of the candidate's training
Special Consideration (Graduates from a non-ABGC/ACGC Accredited Program)
Graduates from a Canadian non- ABGC/ACGC Accredited program that has received pre-approval from CAGC Certification Board.
Certified genetic counsellors (GCRB or HGSA; other certifications may be considered) who graduated from a Masters program in Genetic Counselling from a non-Canadian university and from a non-ABGC/ACGC-accredited program.