Candidate’s Handbook

General Information

American Clinical Board of Nutrition

The American Clinical Board of Nutrition (ACBN) is a testing agency that certifies qualified health care providers seeking Board Certification in nutrition. The ACBN is accredited by the National Commission for Certifying Agencies (NCCA), and a member of the Institute for Credentialing Excellence (ICE). The ACBN adheres to a number of rigorous criteria regarding the conduct of its credentialing program. All ACBN examinations are constructed and administered in accordance with methodologies recognized by psychometric and credentialing communities.

Purpose of the Certification Examination

The two (2) part ACBN examination is intended to evaluate the competence of qualified health care providers in the field of clinical nutrition. The test addresses current areas defined and validated by subject-matter experts, educators and individuals working in their respective fields.

Reasons for Testing

The ACBN examination is given to protect and assure the public those providers who hold a diplomate certificate in nutrition and certified by the ACBN, have attained a superior level of knowledge, skill, and professionalism in the practice of clinical nutrition.

To assure the public and patients that they have access to an effective health care service in the practice of nutrition.

To be able to quantify the knowledge retained by the certificate holder(s) from their education in the principles of clinical nutrition and to modify educational deficiencies brought out by the examination process.

To be able to set the certificate holder(s) apart from their peers in the healing professions in terms of their knowledge and use of the principles of current concepts in clinical nutrition.

By means of an examination the recommendations for educational processes and subject materials can regularly be improved and kept current with new and developing concepts.

Examination Development

Examination Committee

Examinations are developed by the Examination Committee (also referred to as the Examining Committee) of the American Clinical Board of Nutrition. Examination Committee members are subject matter experts who are responsible for constructing examinations within their disciplines. In addition to generating and updating specifications on which the examination is based, the Examination Committee writes test questions for the two part written examination and case histories. Test questions and elements of the case histories and written exam submitted by instructors, subject-matter experts, practitioners and others are evaluated by the Examination Committee. The Examination Committee also determines certification requirements and addresses standard setting issues. After construction by the Examination Committee, examinations are subsequently reviewed and approved by the ACBN governing board.

Competency Outline/Role Delineation Studies

The American Clinical Board of Nutrition administers “competency-based” certification examinations. A competency-based testing strategy involves assessing whether or not examinees possess the skills and knowledge required for successful performance in a particular job role.

The first step in the development of this type of test is to define the work role by listing the areas in which a certificant must be competent. Such a list may include a variety of aspects addressing knowledge of procedures, knowledge of theories, and application of theories in addition to a number of other knowledge and skill-related statements. In the development of the ACBN examination, the American Clinical Board of Nutrition currently uses the company Castle Worldwide in the development, distribution, psychometric evaluation and publication of a Field Study and Delineation Report. Test items developed by subject matter experts represent the consensus of experts regarding the composition of the respective work role. Test items are circulated to a random sampling of Diplomates with the American Clinical Board of Nutrition. These items are then classified into several dimensions. Once the number of questions exceeds the number of questions allowable on a particular test, examinations containing only a sample of the items are used. However, during test construction, the items are drawn from the bank in such a way as to ensure that representative samples of competencies are assessed. All test items are reviewed by Castle Worldwide to be psychometrically and grammatically correct.

Examination Format and Content

Examination Format

The ACBN examination consists of two parts:

1. Case Histories: The candidate must write three (3) case histories on actual patients they have seen, from entrance history to follow-up and release. The criteria, methodology and format for writing case histories are a part of the 300 hour clinical nutrition educational program taught in the schools. This is a post graduate program and must be completed three months prior to sitting for the examination.
2. Written Examination: The ACBN written examination consists of two parts of 75 multiple choice questions in each part for a total of 150 questions. There is only one right answer for each question.

Examination Content: What is covered on the examination?

The general content outline for the certification examination is presented in a subsequent section of this manual. The percentages of questions indicated for each content area is explained in the Delineation Report.

All candidates are examined utilizing the same form of the comprehensive examination. No equivalent forms of the examination are needed.

Subjects Covered on the ACBN Examination Include

1. The Biochemistry and Physiology of Nutrition.
2. The Nutrients and their Characteristics, Functions, and Metabolism.
3. The Diagnostic Evaluation in Clinical Nutrition.
4. Nutritional Considerations in Clinical Geriatrics.
5. Nutrition in Infancy, Adolescence, Pregnancy, and Lactation.
6. Dietary and Nutritional Aspects, and the General Management of General Disease: 
1. Oral Cavity
2. G.I. Tract
3. Cardiovascular – Pulmonary Disease
4. Urogenital System
5. Diabetes Mellitus and Hypoglycemia
6. Musculo – Skeletal Disorders
7. Fever and Infections
8. Blood Disorders
9. Disorders of the Endocrine System and Metabolism
10. Trauma
7. Nutrition and the Physiology of Stress
8. Dietary and Nutritional Aspects and Management of Neurological and Neuropsychiatric Disorders
9. Nutrient – Nutrient and Drug – Nutrient Interactions and Reactions
10. Radiographic and Advanced Imaging Diagnosis of Common Metabolic Disorders
11. Herbs, Botanicals, and Homeopathy
12. Longevity and Nutrition
13. How to Perform and Write Research Papers

Topics Covered on the ACBN Examination

1.     Nutritional consultation, case history & physical examination including anthropomorphic measurements.

2.     Nutritionally related biochemistry, physiology & pathology to include carbohydrates, proteins, fats, energy metabolism, vitamins, minerals, trace elements, and water.

3.     Diagnostic evaluation in clinical nutrition, including functional laboratory analysis by blood, stool, saliva, hair, urine, special studies and radiography

4.     Geriatrics – anti-aging, longevity and degenerative diseases.

5.     Pediatric nutrition, pregnancy, and lactation.

6.     Female nutrition including menarche through menopause. This is also to include male nutrition including prostate and urological problems.

7.     G.I. nutrition including paraenteral nutrition.

8.     Renal nutrition and male specific problems.

9.     Endocrine and metabolic disorders, including stress.

10.  Sports nutrition including trauma.

11.  Musculo-skeletal disorders and syndromes.

12.  Neurological and psychiatric disorders including neurotransmitters and neuromodulators.

13.  Herbs, botanicals, and homeopathy, nutrient-nutrient, drug-nutrient, and herb-drug interactions and reactions.

14.  How to write a scientific paper/case history for publication and perform literature searches.

15.  Allergies and immunological disorders including HIV/AIDS and infections.

16.  Cardiovascular and pulmonary nutrition.

17.  Bariatrics including obesity, weight loss and eating disorders.

18.  Nutritional considerations in cancer.

19.  Psychology of nutrition, food preparation and public issues.

20.  Cultural, religious, and ethnic dietary concerns.

Examination Performance Standards

Cut Scores

To determine the cut score or “passing grade” for the ACBN examination, each examination element is reviewed independently by qualified experts in the field and through Castle Worldwide’s psychometricians and grammarians.

Item raters begin by identifying which answer choices the minimally – competent health care provider should be able to eliminate as clearly incorrect. The number of remaining answer choices determines the probability of choosing the correct answer. The average of all reviewers’ judgments determines the minimum passing level for each text item.

The odds of answering an item incorrectly can be thought as the item’s difficulty. Each item has its own difficulty. After the Examining Committee has reviewed each item, including which of the four (4) responses to each item the minimally-competent examinee should be able to perceive as incorrect, the judge’s ratings are pooled to obtain the minimum passing level. The minimum passing level settings for both parts of the ACBN examination are then totaled to determine the minimum passing level for the entire examination.

All ACBN examinations consist of two parts, the writing of three (3) case histories and the 150 question written examination.

Passing the Examination and Re-examination

The minimum passing score for the case histories is 30 out of a maximum of 40 points.

The minimum passing grade for the written multiple choice examination is variable depending on the psychometric evaluation of the test which is changed every year.

A candidate who has failed one or more parts of the ACBN examination may elect to be retested. In order to retake any one of the two parts of the ACBN examination; writing of 3 case histories, or the 150 written multiple choice test, a candidate must submit, in writing, a request to do so accompanied with check payable to the ACBN in the amount of $300 for each part they wish to retake.

A candidate may retake any part of the ACBN examination within three (3) years of the initial, formal application submission. A candidate may elect to retake any part of the exam three times.

At the discretion of the Board, a request to sit for any portion of the ACBN examination a fourth time may be considered. To be considered a fourth and final time, the candidate must provide evidence of having had a preceptorship by a diplomate acceptable to the Board for a period of not less than one year, and upon the recommendation of the preceptor.

If a candidate should fail a fourth attempt to successfully pass the ACBN examination, it will be necessary for them to submit to taking the entire examination, as well as providing satisfactory evidence of completing and additional one – hundred (100) hours of further education in the area of nutrition prescribed by the Board.

Examination Administration

Application

The formal application to sit for the ACBN examination may be obtained online at www.acbn.org. or by calling ACBN headquarters at (540) 635-8844.

Authorization to Test

Qualifications to Test

All applicants interested in sitting for the ACBN examination must:

1. Be a licensed professional health care provider who has successfully completed 300 clock hours of specialized postgraduate training in nutrition from a college , university, institution, foundation, or agency holding status with an accrediting agency recognized by the U.S. Department of Education, or an agency having a reciprocal agreement with the recognized agency OR a health care provider who has completed a 300 clock hour residency program from a college, university, institution, foundation or agency holding status with an accrediting agency recognized by the U.S. Department of Education, or an agency having a reciprocal agreement with the recognized agency.
1. Residency programs must be approved by the Board.
2. Residency programs must file with the Board, the number of hours of teaching experience, research and training that is performed by the candidate.
3. A syllabus of the residency program must be submitted to the Board.
2. Candidates must write a nutrition oriented article or paper acceptable by the Board for publication in Board approved journals, such, but not limited to:

            J. Nutritional Perspectives

            Journal of Nutrition

            JMPT

            Am. J. Clinical Nutrition

            J. Chiropractic Medicine

            Nutrition Reviews

3. Candidates must have had a minimum of two (2) years practice experience in nutrition prior to sitting for the ACBN examination.

  Once a candidate’s application is complete and has been officially approved by              

  the ACBN Examination Committee, an authorization letter will be sent to the

  candidate.

4. Applicant’s Right of Appeal. An applicant deemed ineligible to sit for the ACBN   

      examination may appeal the Boards determination (See Policies and     

      Procedures XIV – Grievances, Discipline and Appeals).

Identification

Each candidate authorized to sit for the ACBN examination will receive in their authorization letter, a four (4) digit personal identification number (PIN). This number is to be used on all tests, forms and test results. During the actual examination, name badges will be provided and worn by the candidates for the proctor’s ability to identify each person authorized to be in the room. The name badge will not have the candidate’s PIN number, but will supply the candidate’s name and picture for identification purposes only.

Candidates arriving at the examination site, prior to receiving their name badge and before entering the examination room, must present to the proctors at least 2 forms of identification; one of these must bear a recent photo. Candidates must present one of the following as the primary form of identification: Passport, photo-bearing driver’s license with signature, photo-bearing employee identification card, or military identification. The secondary form of identification may include any of the above or a credit card. Examinees not providing acceptable identification will be refused admission to test and will be required to pay a re-examination fee and reschedule another testing appointment.

Cost of Examination

Each candidate must submit, as part of the formal application, a non - refundable fee of $1,500 payable to the ACBN using a certified check.

Setting a Date and location for the Examination

A minimum of 6 candidates must be ready to sit for the ACBN examination before a date and location is announced. The Board will make every effort to place the location of the examination that is closest to the majority of candidates applying to sit for the examination. The date of an examination will be within four (4) months after having had the minimum number of candidates apply to sit.

The Day of the Examination

Examinations are administered as scheduled in advance with the ACBN. Candidates are responsible for their airfare/transportation, lodging and food during this time. Air/ground and hotel arrangements should be made with the ACBN travel agency: Trump Travel at (800) 937-3878.

All personal belongings, including but not limited to: overcoats, purses, handbags, backpacks, cameras, tape recorders, cell phones will be left with the proctors before entering the examination room.

If it becomes necessary for the examinee to be excused to a restroom, he or she will be escorted by a proctor to and from the restroom.

No visitors are permitted in the examination room.

All cell phones will be turned off.

Promptness

Examinees are advised to be at the test administration site at least 30 minutes prior to the scheduled examination time to allow for check-in. Examinees arriving late may be refused admittance by the ACBN proctors. Should this occur, the candidate will be required to pay a re-examination fee and reschedule another testing appointment.

Important Information for all examinees

Questionable Test–Taking Behavior

Proctors have been given specific instructions regarding questionable test – taking behavior, or “cheating”. Such behavior includes, but not limited to: examinees copying from one another, examinees speaking to one another during the test administration, or copying from notes.

If a proctor is witness to such behavior, they have been instructed that to avoid any disruption to the decorum, the examinee will be allowed to finish that part of the examination. Once the exam part is completed, the proctor will immediately gather up all test materials from the examinee in question and advise them of the infraction. That part of the examination will not be graded. Those examinees should then contact ACBN headquarters to schedule another examination administration.

Score Cancellation

The American Clinical Board of Nutrition reserves the right to cancel any examination scores if, in the opinion of the Board, there is any reason to question the score’s validity. The Board also retains the right to investigate instances of examinee misconduct.

Score cancellation circumstances may include, but are not necessarily limited to the following cases of misconduct; copying from notes, copying from others, speaking to other during test administration, giving assistance to other examinees, or removing test materials from the administration room. If the Board should exercise the right of cancellation, the examinee(s) will be offered the opportunity to retake the exam at the next scheduled testing. All required fees will be in force.

The Executive Board member of the ACBN overseeing the examination proceedings, acting under authority of the Board, renders decisions regarding score cancellations. Significant score increases upon retesting may also be investigated to ensure the authenticity of results.

Special Accommodations

The American Clinical Board of Nutrition is committed to ensuring that no individual is deprived of the opportunity to take the examination solely by reason of disability and adheres to the standards of the Americans with Disabilities Act of 1990. Special accommodations may be provided for candidates with documented disabilities. Candidates requesting special provisions must state their needs in writing as shown on the formal application form. Requests should include, but are not limited to: documentation of the disability, accommodations requested for the examination and descriptions of past accommodations provided in other cases.

Whenever possible, the ACBN office will determine applicant eligibility for special provisions. Candidates should allow the ACBN reasonable time to review the request, and if warranted, make provisions to provide an accommodation. The examination proctors will be notified if special considerations are granted.

Necessity to Bring Own Interpreter if Language other than English

All ACBN examinations, materials, and supporting documentation are in English. A candidate who is Board eligible to sit for the ACBN examination, or a certificant who is required or wishes to retake any part of the ACBN examination and does not know the English language, must provide for an interpreter.

The interpreter will be selected by the ACBN. The candidate or certificant requesting an interpreter will be responsible for any and all fees for securing an interpreter, include their airfare/transportation, hotel, food, as well as a fee for their services.

Examination Results

Scoring Procedures

Following scoring of the examination, examinees will receive a letter notifying them of their examination performance. Passing examinees receive a letter indicating the passing score on the examination. Candidates who have failed will receive a letter advising them that they have been unsuccessful in one or more parts of the examination. Unsuccessful candidates will be provided information regarding the parts of the examination in which they received low scores. Unsuccessful candidates may consider these areas of weakness in preparation for retesting.

Processing Time

Examination results are made available 6 – 8 weeks upon completion of the computer based and hand written examination.

Posting of Scores

While the examinees will receive a letter notifying them of their examination results, these same results will also be posted on the ACBN website, using only the examinee’s confidential PIN number for identification. This is necessary for all ACBN stakeholders to view.

Score Verification and Rescoring By Hand

Examinees receiving failing scores may request rescoring of the answer sheet that they completed. Rescoring requests must be submitted in writing to ACBN headquarters accompanied by a $50.00 rescoring fee. Upon receipt of a written request and required fee, the examinee’s answer sheet(s) will be graded by hand. The ACBN will notify of the hand scoring results. Rescoring requests must be received no later than 60 days following the original release of results for the particular examination or part thereof. requests received after 60 days will not be honored. Similarly, requests for hand scoring of prior examinations will not be honored (unless they were administered less than 60 days prior to the request).

The ACBN does not encourage examinees with close to passing to request hand scoring. Quality control procedures are performed during the time of initial scoring. These control procedures include the hand scoring of a sample answer sheet to verify the corrections of the machine scored key. Therefore, it is highly unlikely that examination results will change from fail to pass if rescored by hand.

Results Appeals Procedures

Candidates receiving a validated failing grade have the right to appeal. An unsuccessful candidate wishing to review an examination must file a written request with the ACBN within 60 days after the original release of test performance results, or within 30 days after the release of hand scoring results, whichever comes last. Reviews may be held at a Board recommended location. However, the requesting examinee will be required to pay for any and all travel, lodgings, food or other expenses incurred by the ACBN for the review process.

If the examinee requests their personal appearance at the review, they may do so at their own expense. They may not be accompanied by any other person other than the ACBN examining committee member. Prior to the review, the examinee will be asked to present photo identification: driver’s license, employee identification card, passport, etc. The examinee will receive a copy of the test in question and a copy of his/her answer sheet.

In the presence of the examining committee member, the candidate may review the examination for a maximum of one (1) hour unless more time is specifically requested. The examining committee member can not defend the examination, attempt to answer any questions, or refute any question(s) during the review process. The candidate will be provided with a review form on which to offer comments, questions, or claims of error contained in the examination. The review form will be presented to the entire examining committee for review and comment and will be retained at ACBN headquarters.

Although bound reference books will be permitted, tape recorders and other reproduction devices are prohibited in the review room. The candidate will be permitted to write only on the review form, and will not be allowed to remove anything from the area. The candidate will be required to sign an agreement to this effect prior to the review. Should it be necessary for the candidate to leave the review area at any time, all materials will be collected and returned to the candidate upon their return.

Reexamination will not be permitted within 30 days of the date upon which a review took place.

Maintenance of Examination Quality and Test Security

Collection and Review of Statistical Indices

After each answer sheet is scored, statistical reports are generated that show how each question in the test performed. The results of these analyses are reviewed by the examining committee who makes the final determination regarding the suitability of a particular question and the answer to that question for future tests.

Test Security

All examination materials, including draft materials, electronic forms, reports, answer sheets and data analyses files will be retained in a secure location and inventories in detail.

All validation materials, including the production of job analysis data, content specifications, examination blueprints, and source documents are retained, inventoried and controlled with limited access in a secure location.

Personnel of the Board, identified Board members and consultants will have access to the assessment instruments and associated data.

Documentation logs will be kept, outlining who is assessing which materials on specific dates and times.

All assessment materials, test materials, answer sheets, blueprints and source documents will have control numbers for quality control and security.

Electronic information will be backed up routinely and all efforts to safeguard electronic data, such as fire walls will be used. Electronic data will be maintained indefinitely while printed material will be shredded after seven (7) years.

Personnel of the Board, identified Board members and consultants must sign a confidentiality form prior to securing any test or candidate information.

All candidates are assigned a four digit personal identification number (PIN) to ensure test and identification security.

All examinations will be sealed by the examiner(s) responsible for the exam; to be broken only by those same examiners responsible for  administering the exam and by affixing their signature, attest to the security of the examination.

                        Applying to Take the ACBN Examination

Filing an Application

Requests for applications should be made to:

ACBN Headquarters

c/o Ms. Bonnie Sealock, Correspondence Secretary

6855 Browntown Road

Front Royal, VA  22630

Voice: (540) 635 8844

Fax: (540) 635 3669

Email: conacbn@shentel.net

Applications can also be downloaded from the ACBN website: www.acbn.org

When submitting an application, candidates should pay strict attention to the required documentation. It is the candidate’s responsibility to keep abreast of the progress of the application and to aid in the timely response of references and required documentation.

Potential examinees must file an application several months prior to an announced examination date to allow examiners time to review the required nutrition article and to grade the required 3 case histories. Within three (3) weeks of receiving a correctly completed application and appropriate fee(s), the candidate will receive a letter of authorization allowing them to sit for the examination. This letter will advise the candidate of their personal PIN number, the date, location and time of the examination. If there are any deficiencies in the application the candidate will be notified at this time.

Examination Components

Prior to sitting for the examination, a candidate must write a nutrition oriented article or paper suitable for publication. (Refer back to the section “Authorization to Test – Qualifications to Test”)

1. Case Histories

Every candidate must write three (3) case histories. A case history is a written narrative showing all aspects of the health care provider’s care of an actual patient, from history taking to follow-up and release from care. Classes on how to write case histories are a part of the 300 clock hour nutrition education diplomate courses provided by colleges that teach the nutrition diplomate coursework. For a list of colleges providing these and other educational modules, contact ACBN headquarters.

Once the coursework is completed, the candidate should start fielding appropriate patients whose condition(s) may warrant a complete nutritional case history protocol. These are the cases the candidate is expected to perform all necessary elements of a case history: History, Examination, Assessment, Diagnosis, Treatment, and Outcomes (follow-up). 

What to include in your Case Histories: This is a suggested list of areas you should address and discuss in your case histories. Samples of case histories are available at a fee by contacting ACBN headquarters.

The following list is taken from the Case History Examiner’s Results Form:

• Personal and family history
• Medicines, supplements taken
• Food allergies
• Surgeries
• Food likes and dislikes, and why
• Diet diaries – 7 day diet diary preferred
• Exercise habits
• Liquid consumption
• Presenting symptoms including those of possible contribution
• Anthropometric assessment
• Examination findings: nutritional, physical, laboratory, x-ray, special studies
• Diagnosis: initial, working and final
• Treatment program(s) and rationale for
• Progress
• Follow-up and/or outcomes

Once the three (3) case histories are completed, the candidate must make four copies of each case history. One copy is as a “hard copy” and the other 3 must be on CD. The hard copy and the 3 CDs of each case history are to be sent to ACBN headquarters 3 months prior to sitting for the written examination. One copy is retained in the candidate’s file and the other three are distributed to the examiners for grading.

 Effort should be taken to blot out any identifying names of the doctor or patient in the case histories. 

Place your PIN number only on the first page of each case history. Examiners do not know whose case histories they are grading nor do they discuss any case history with any other examiner unless there is a discrepancy in grading.

An inter-rater reliability study has been performed to reduce any question of grading irregularities. If such an irregularity should occur, an examiner who has not reviewed the case history in question will adjudicate the differences.

When submitting your case histories, you will be required to sign an attestation form stating that the case histories submitted are of your own work and was performed without surrogate writers. This form can be found in this manual under “forms”, or can be downloaded off the ACBN website.

All case histories submitted become the property of the ACBN with all rights to duplication and usage.

Scoring/Grading of Case Histories  

The Case History Results Form is what the examiners use in scoring case histories and is located towards the end of this manual under “forms”. Review this form and be sure all areas of examination are supported and documented.

Posting of Case History Scores (Grades)

Candidates will receive their case history scores 4 – 6 weeks after submission of the case histories to the ACBN for grading. The candidate’s score will also be posted on the ACBN website and identified only by their PIN number.

Acceptable Examination, Laboratory and Diagnostic Usage

The ACBN recognizes examinations, laboratory and diagnostic procedures that are well accepted in the scientific community. AN ICDA diagnosis description and its code must be provided. The diagnosis must conform to ICDA guidelines.

Examination and laboratory procedures not considered established and well accepted in the scientific community may not be used as the sole indicator for a diagnosis. Procedures that are not well accepted may be used as adjunctive and supportive indicators only but can not be used on their own. Examples of adjunctive procedures are, but not limited to:  Applied Kinesiology, Dark Field Microscopy, Hair Analysis, Iridology, Reflexology, and Classic Chinese Diagnosis.

2. Written Examination

The written examination is in two (2) sections, each containing 75 multiple choice questions, totaling 150 questions. Each section has a time limit of 1 1/2 hours with a 45 minute break in between. Each multiple choice question has only one right answer of the 4 choices provided.

The candidate will be provided the question packet and a separate answer sheet. The answer sheet may be a computerized form. Only the candidate’s PIN number is to be placed on the answer sheet.

Scoring the Written Examination

Each part of the two part written examination is graded by electronic means with the cut score having been determined prior to the examination.

Posting of examination results

The candidate will receive their scores on each part of the written examination by certified letter 4 – 6 weeks after the exam has been administered. Scores will also be posted on the ACBN website using only the candidates PIN number for identification.

Appealing Examination Results

Every Candidate is entitled to the process of appeal. Please refer to “Examination Results, Results Appeals Procedure” reviewed earlier in this manual.

Duties and Obligations of Certificants

Once a candidate has successfully passed the entire ACBN examination and has been notified by certified letter by the ACBN Board of their success, the new certificant has duties and obligations they must adhere to in order to maintain their certification status as a diplomate with the American Clinical Board of Nutrition. These include:

1. Must have paid the annual certification fee.
2. Must satisfy annual educational requirements. A certificant must attend one (1) out of every two (2) years, an ACBN approved nutritional educational seminar(s) of minimally twelve (12) credit hours of nutrition education. On the alternate year the certificant must demonstrate to the Board evidence of any of the following:
1. Be actively engaged In nutrition education at a college, university, foundation, institution, or agency having status with the U.S. Department of Education, or an agency having a reciprocal agreement with the recognized agency.
2. Submit a paper on nutrition for publication with a minimum of ten (10) references.
3. Submit at least two (2) case histories suitable for publication.
4. Submit evidence of having attended any 12 Credit hour nutrition seminar (does not need to be ACBN approved). The seminar must be sponsored by any college, university, institution, foundation, or agency having status with the U.S. Department of Education, or an agency having a reciprocal agreement with the recognized agency.

Certificants who have not complied with the “duties and obligations of certificants” may be decertified. The Board will review the circumstances of failure to adhere to the duties and obligations of a certificant on a case by case basis.