Certification Application Form (For CRS Members)

Please fill all relevant information that is requested. Please follow instructions that show on the right side when you hover over each section of the form. Sections marked by asterisks are mandatory.

CRS Membership Number *

If you are a CRS Member, please furnish your Membership number. Failure to provide your membership number may lead to delay in providing access to the training portal and or scheduling of the certification examinations.
CRS certification you would like to apply for *
Prefix *
Name Name * First Last
Institution/Company/Organization *

Please provide a complete name of the educational institution. (example: University, College, Training Institute, School)
Designation

Use letters only to enter your designations (example: MD, RN).
Your Address Your Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Select one: *

Select one: This is my home address This is my office address This is neither my home address nor office address but i would like all communication to be sent here
Preferred Phone Number *
Email *
What is your most advanced degree? *
Work experience in clinical research (In hours) *

Please provide your number of hours of experience in clinical research. Before you apply, please ensure that you meet the eligibility requirements for the certification you are applying for.
Proof of work experience (Optional Now)

Attach Files

Please upload an appropriate proof of work experience. One of the following can be used - copy of letter from current or former employer or contracting organization, copy of identity card, copy of business card, or any other document that demonstrates work experience in clinical research. If you don't have one while submitting your application, you may send it to us through an email at membership@clinicalresearchsociety.org within 7 working days from the date of application submission.
Clinical Research Education Program Completion Certificate, if applicable (Optional now)

Attach Files

If you are claiming eligibility based upon completing an education program of more than 150 hours in clinical research, please upload a copy of the Course Completion Certificate. If you don't have supporting documents while submitting your application, you may send them to us through email at certifications@clinicalresearchsociety.org within 7 working days from the date of application submission.
Upload your CV (optional)

Attach Files
Job description (optional Now)

Attach Files
Disclaimer *

Disclaimer I agree to have provided correct information to the best of my knowledge.