Application for training facility accreditation

Applicant name

An applicant must be an individual who has been certified by ACE and an Embryologist (EMB) or is expected to be certified within 30 days following submission of this application.

EMB certificate number

The certificate number is located in the corner of your EMB certificate.

Applicant email

Applicant phone number

Applicant mailing address

Embryology Facility Name

Embryology Facility address

Associated University

Include the name of an educational organization associated with your Embryology Facility.

Embryology facility website address

Number of cycles

Enter the number of egg retrievals performed during the past year.

Pregnancy rate in 2016

In order to qualify as ACE accredited training site your program must be rated within 25% best in the United States based on pregnancy rate per transfer for women under the age of 35 your facility has reported to SART/CDC in 2016 It must be 51% or higher OR your facility has to be within the top 25% for implantation rates resulting from single embryo transfers according to IVF REPORTS^TM calculations extrapolated from the SART data.

Number of practitioners in the facility

Additional information

Describe your reasons for applying to become American College of Embryology accredited training facility.

Signature

By signing this application I certify that the above information is accurate to the best of my knowledge.

Sign your application as / John Smith /