EPC
APPLICATION
to sit for the
Board CertifiedExercise Physiologist
EXAM
American Society of Exercise Physiologists
Board of Certification
INSTRUCTIONS FOR EPC CANDIDATES
- Complete the EPCApplication to sit for the exam.
- Regardless of whether you are presently a Memberof ASEP or not, a Check for $425 (i.e., $300 for the EPC Application to sit for the exam and $125 to be recognized as a Certified Professional Member) must be made payable to ASEP.
- Please be sure theCheck (made out to ASEP),Official Transcript(s), and the completed EPC Application are mailed to:
c/o Tommy Boone, PhD, MPH, MAM, MBA
104 Taylors Cove
Beaumont, TX 77705
REVIEW OF APPLICATION
After a complete set of documents has been received, you will be notified in writing of the Boards' determination of your qualifications to sit for the exam.Any misrepresentation of the content in the EPC Application and/or your identity at the exam (as determined by the designated proctor) will result in forfeiture of EPC status.If you do not qualify to sit for the exam, the Check is returned to you or destroyed.
The
EPC Application
"Exercise Physiologist Certified"
SECTION #1
Personal Information:Print your full name as you wish it to appear on ASEP documents and correspondence. Print your mailing address where you want theEPC exam score, EPC Certificate, and all other ASEP correspondence to be mailed.It is your responsibility to notify the ASEP National Office of an address or email changes(using the Email: ).
NameLast ______First ______Initial ______
Mailing AddressStreet ______City______State______Zip______
Telephone Number(____)______Email______
SECTION #2
Membership Information: Are youan ASEP member? Yes____No____ (Check one)
SECTION #3
Academic Information: It is important that you are either in your final semester of college and, therefore, will have finished the required courses and completed graduationbefore the completed EPC Application is received by the ASEP National Office or you have already graduated at the time of completing the EPC Application. Regardless of which one, enclose an OFFICIAL transcript listing of degree(s) and graduation date(s). It is the candidate’s responsibility to send official transcript(s) to the ASEP National Office at the time the EPC Application is sent. Complete the following:
Institution(s) Attended Dates Attended Degree Received
______
______
SECTION #4
Academic Course Work:Please highlight in yellow the ASEP-Required Courses on yourofficial transcriptsthat either matches or comes close to matching the list of Required Courses. Then, match up the identified courses on the transcript(s) with the ASEP-Required Coursesbelow.If necessary, refer to the EPC Guide using the URL: 1for course title comparisons).
Required CoursesCatalog #Course Title
Exercise physiology______
Cardiac rehabilitation ______
Exercise metabolism ______
Kinesiology ______
Research design ______
Sports biomechanics ______
Environmental physiology ______
Sports nutrition ______
SECTION #5
Confidential Property:The EPCApplicationmaterials are confidential property of Board of Certification. Any request by an outside source to review the materials will be denied. Please indicate that you have read, understand, and agree to the ASEP Confidential Property statement.
Yes No (Circle one)
Read the content of the following paragraph. If you agree, print yournamein the blank at the top of the paragraph and sign your name at the bottom and date the submission of the EPC Application to the ASEP National Office.
I, ______, make this application for bona fide certification purposes only and will not disclose any information regarding the content of the examination, test questions, or test materials of any kind. I authorize ASEP to communicate the outcome of my examine score to any and all public sector authorities, employers, and others as it relates specifically to the use of the titles – Exercise Physiologist Certified or Board Certified Exercise Physiologist. I consent to and authorize ASEP to request information relevant to this application and my eligibility, certification, recertification, and review of certification and for any entity to furnish this information to the Board of Certification of the ASEP National Office. I hereby release, discharge, and exonerate ASEP, its officers, directors, employees, committee members, agents, and any person furnishing documents, records, and other information relating to my eligibility, recertification, or review of certification, from any and all liability of any nature and kind arising out of the furnishing or inspection of all documents, records, and other information and any investigation and evaluation by ASEP.
______
Candidate Signature Date
Copyright ©1997-2014
American Society of Exercise Physiologists
All Rights Reserved
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