Print Page   |   Sign In   |   Join NAHAM
Examination Date Change or Period Deferment Form

Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

The form below should only be completed if you are changing examination dates within the same testing period or to the next consecutive period.  Testing periods are held for the entire months of January, April, July and October. Prior to completing this form you need to notify your proctor of your intent to change and agree on a new testing date.

Once the form is complete and submitted, please mail a check payment with a copy of the form attached to:

8634 Solution Center

Chicago, IL 60677

Select the approriate item below

Please enter the Original Date on which you were scheduled to take the exam: (MM/DD/YY)
To change your date you must meet the following criteria:

You wish to change your examination date to the next examination administration period (Example: You are testing in January and you wish to change your examination date to April).

Enter the New Date on which you would like to schedule your exam (Must be during one of the four testing periods NAHAM offers: January, April, July, and October)
Have you arranged to have the same proctor for your new examination date?

If no to above question, you must enter the requested proctor information below for your form to be complete. Do not insert TBD
1) I wish to change my examination date to the next examination administration period.

2) My proctor is aware of the new date and is available to proctor.

3) Upon submitting this form, NAHAM has all the additional information they need and I do not expect to receive additional materials or information regarding this date change.

4) I understand that NAHAM will confirm with my proctor that they have the mecessary materials to properly administer the examination.

5) I understand that I can only change my examination date one time or I will have to pay the full application fee.

Community Search
more Calendar


© National Association of Healthcare Access Management
2025 M Street NW, Suite 800: Washington, DC 20036
(202) 367-1125 :

Association Management Software Powered by®  ::  Legal