Associate Certification Final Application - American Society of Diagnostic and Interventional Nephrology

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Associate Certification Final Application

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If there are any issues in the upload/submission of this form, please use the following uplink - https://www.hightail.com/u/ASDIN for file uploads and notify the ASDIN office at info@asdin.org.

First Name *
Last Name *
Email Address *
Have you received approval from ASDIN on your Initial Certification Form *Applicants must have submitted the Initial Application form to ASDIN and had it approved in order to continue with the application process.	Yes No
Do you have 2 years of experience in the field of Int. Nephrology, Vasc. Surgery, or Int. Radiology *	Yes No
Are you currently in a direct patient care role in a vascular interventional theater *	Yes No
Do you hold a current license by a state board of nursing or from ARRT *	Yes No
Do you attest to uphold the ethical standards outlined in this document *	Yes No
Do you attest to utilize established universal precautions and guidelines *	Yes No
Upload Clinical Experience Form *Applicants should only include the the Clinical Experience Form (pg. 14) in this upload.

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