Recertification Application

RST Recertification Application

Personal Information
Name*
RST #*
RST Date Earned*
Date Format: MM slash DD slash YYYY
Cell or Home Telephone
Work Telephone
Email Address*
Eligibility Status
- I am currently certified in Basic Life Support for Healthcare Providers
  (All candidates must be certified - attach a copy of an unexpired card)
- I have uploaded certificates showing at least 50 sleep-related continuing education credits earned in the past five years to the ABSM credit-tracking site http://my.absm.org/registrationselect.aspx
- I intend to take the RST recertification examination prior to my certification expiring. Please send me instructions for registering for the exam.
Basic Life Support Card*
Accepted file types: jpg, jpeg, png, pdf.
Attestation
*
By typing your full name below, you hereby declare the following: That all information contained in this application and all documentation submitted with or in support of the application is true. I understand that the ABSM conducts random audits as part of the recredentialing process. I understand and agree that any misrepresentation of said facts will result in revocation of the credential obtained.
Fee Schedule
Recertification Fee*
- Recertification Fee ($50.00)
- RST Exam ($175.00)
Extension
- One-time 90-Day Extension Fee ($50.00)
Total
$0.00
Billing Address*
This address must be associated with your credit card.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

RST Recertification Application

Personal Information

Eligibility Status

Attestation

Fee Schedule