APPLICATION FOR CAST CERTIFICATION IN NEUROCRITICAL CARE
Applicant Name: _________________________________________________________
Academic Title: __________________________________________________________
Institution: ______________________________________________________________
Mailing Address: _________________________________________________________
City/State/Zip: ___________________________________________________________
Email: __________________________________________________________________
Phone: _________________________________________________________________
Assistant’s Name/phone/email:______________________________________________
Department Chair: ________________________________________________________
“GRANDFATHERING” PROVISIONS - PRACTICE TRACK: The following are specific
criteria for CAST certification in Neurocritical care for neurosurgeons or other specialists who
have already completed training and have had additional training and experience in Neurocritical
Care prior to the availability of CAST accredited training programs. The applicant must supply
the following information and documentation:
Completion of training in neurological surgery or other ACGME accredited training program.
Name of training program/Specialty_________________________________________
Year of residency completion______________________________________________
Board Certification:
If ABNS certified please supply the following information:
ABNS Certificate# _____________Year of ABNS certification_________
If certified by an American Board of Medical Specialties board other than the ABNS:
Name of the certifying board_________________________________________
Board Certificate#______________ Year of board certification______________
Completion of a non-CAST fellowship in critical care or neurocritical care (e.g.
UCNS, ACS, Anesthesiology, Neurotrauma and critical care fellowships, etc.) Please
attach Board Certifications or a letter from Fellowship Director.
Program name_____________________________________________________
Year of fellowship completion_______________________________________________
Fellowship Director Name__________________________________________________
AND
Documentation of extensive experience in neurocritical care and an active hospital
appointment in critical care. Please include a letter from the Chair of Neurosurgery and/or
Chief Medical Officer documenting your experience and active hospital appointment in
critical care.
Please attach a letter containing any additional information of importance to support your
request for certification as well as a current CV.
This practice track pathway for certification will close on the last day for applications for the
2020 CAST program accreditation cycle. To apply via this pathway, physicians must have
fulfilled the requirements of the pathway on or before that date and must have active and
unrestricted primary ABMS Certification. Certification obtained under the practice track
pathway will have the same limitations as certification obtained via other CAST accredited
fellowship pathways.
Please send the completed application and supporting documentation by mail or email a PDF
along with the $500 application fee to the CAST Secretary’s Office:
Attn: CAST
Steven Giannotta, MD
USC Department of Neurosurgery
1200 N State Street, Suite 3300
Los Angeles, CA 90033
The application fee for a Practice Track application of $500 has been waived until October 30,
2014.
Neurosurgeons and others who obtain CAST certification in Neurocritical care and who are
faculty members at an institution with an ACGME approved neurosurgical residency are
encouraged to apply for a CAST approved fellowship program in Neurocritical Care.
Questions may be addressed to Dr. Giannotta or Michelle Ashley Matthews in the CAST office
at 323-226-7421 or michelle.a.matthews@usc.edu