What Is It?
An innovative program that makes getting certified safer and easier for everyone. The result is everyone wins: nurses, nurse managers, the health care facilities, and patients. In a nutshell, if the nurse uses the unique facility ID Code when registering for the exam they get more than one chance to pass the exam, and don't pay a penny until the nurse passes.
How It Works:
A health care facility agrees that within one year's time, 20 of its nurses will take an ANCC certification exam.
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If the nurse passes the exam, the nurse is charged for the exam fees.
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If the nurse is unsuccessful, they can take the exam an additional time before the contract expiration date.
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If the nurse passes the second time around, then the nurse is charged the exam fee.
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If the nurse does not pass, no one pays if within the contract date.
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If the nurse does not use the unique facility ID Code to register for the examination the fee is the responsibility of the nurse and you will not be covered under the Program.
Benefits of the Program:
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Reduced test stress for nurses: Fear of failure is eased (FailSafe) and confidence increases.
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Better care: Certified nurses provide the best nursing care to patients and families.
Begin by completing the contract below and returning it to cppn@ucdmc.ucdavis.edu

This Contract, made this _____ day of _____, 20___, between (Name) ____________________________ hereafter referred to as “Nurse” and UC Davis Medical Center, Center for Professional Practice of Nursing hereafter referred to as “CPPN” is for participation in the ANCC Success Pays™ Program. Expiration date of contract: 02/02/201
7
Personal Information
First Name
PPS ID No.
__ _____ MI Last Name ___
Title: _______
_____________
__________________________
Department Name: ____________________________________________________________
Permanent (Home) Mailing Address:
Street
Work Address:
City State Zip
Unit: ________ Suite/ Room No. _____________________
Contact Information:
Work Phone Number ________________ Personal Phone Number ______________
Work E-mail address ___________________________________________ al I
Contract Agreement
Responsibilities of the Parties:
I.
Nurse agrees to:
A. Enroll as an applicant for one of the American Nurses Credentialing Center (ANCC)
Certification exams, using the unique ID Code provided by CPPN, during the period of this Contract, hereafter referred to as “Contract Period.”
B. Nurses will complete a certification exam application through ANCC.
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If the Nurse registers for the exam and is unable to meet the terms of this Contract by completing the processes to take the exam (successful or not), CPPN will charge for exam, regardless of a pass or fail outcome as outlined below.
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If the nurse passes the exam, then the exam fee will be charged at that time to the credit card listed.
 If the nurse is unsuccessful, one additional opportunity to re-take the same exam at no additional cost per Contract Period.
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If the nurse does not pass the second time around, within the contract period the nurse will not be charged.
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If the nurse passes the second time around, then the exam fee will be charged at that time to their credit card.
A nurse who registers for but does not take the exam on the selected window for computer-based testing for any reason will forfeit one opportunity to take the exam.
C. The Nurse will provide a valid credit card to CPPN to be charged. All credit card information will be kept confidential and shredded after payment is received.
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I _
ANCC by 1/30/201 7
_ _____ agree to register and complete the examination process for
To register for the examination go to www.nursecredentialing.org/Certification, choose your certification and click "Apply Online." The use of the ID Code will negate the fee charged . Full instructions will be provided with special promotional ID Code
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UCDMC/CPPN will supply a distinct facility promotional ID code to use when registering for the exam upon receipt of this signed contract and valid credit card information.
D O N OT A PPLY FOR THE EXAM UNTIL YOU HAVE RECEIVED U NIQUE ID C ODE FROM CPPN.
I F YOU REGISTER AND PAY
FOR THE EXAM ANCC WILL NOT ALLOW YOU TO CHANGE TO THE S UCCESS P AYS ™ P ROGRAM .
Examination Fees will be charged as follows:
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$ 290.00 Certification by Exam
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$470.00 Certification Through Portfolio
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$350.00 Renewal Fee Applications
Credit Card Information
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Please bring contract and credit card to CPPN, or email form to CPPN and call with credit card information.
Credit Card Information (will be kept confidential and only charged when the nurse passes the exam or fails to complete within the contract time limit.)
If the credit card becomes non valid prior to being charged it is the credit card holder’s responsibility to contact CPPN and update credit card information.
Contract will not be valid until credit card information has been received.
By signing below, I acknowledge the above registration in the UCDavis/CPPN MSNCB FailSafe
Certification Program and agree to pay fees as listed.
Employee Signature:__________________________________ Date: _______________
CPPN Supervisor Signature: ________________ _____________ Date: _______________
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