BOC Certification Guide for Athletic Trainers
The Board of Certification (BOC) is the credentialing body for athletic trainers in the United States. The BOC certification is the standard credential for AT practice and is required for state licensure in 49 states (all except California). This guide walks through the BOC exam preparation, content, and ongoing certification maintenance.
For overall career path, see our How to Become an Athletic Trainer guide.
BOC Exam Eligibility
To sit for the BOC exam, candidates must have completed a CAATE-accredited athletic training program (master's level as of 2022). The eligibility verification is automated through CAATE program completion documentation submitted to BOC. Candidates submit application after program completion plus letter of recommendation from program director.
Internationally trained athletic trainers follow a separate equivalency process through BOC to establish eligibility. The international pathway includes credential evaluation through ECFMG or similar agencies, English language proficiency, and supplemental coursework if needed.
BOC Exam Format and Content
The BOC exam is computer-based with 175 multiple-choice questions plus several drag-and-drop and hot-spot interactive items. Total exam time is 4 hours. Cost is $375. Content covers seven domains:
- Injury and illness prevention and wellness promotion
- Examination, assessment, and diagnosis
- Immediate and emergency care
- Therapeutic intervention
- Healthcare administration and professional responsibility
- Risk management and risk reduction
- Communication and inter-professional collaboration
The exam emphasizes clinical decision-making in athletic training scenarios. Most questions present case scenarios requiring application of AT knowledge to specific situations rather than rote memorization. Strong clinical experience during master's program prepares candidates well for the case-based format.
Pass Rates
First-time pass rates for graduates of CAATE-accredited programs typically run 75-85%. Pass rates have been relatively stable over recent years. Candidates who fail their first attempt may retake the exam after 60 days. Multiple attempts are permitted with $375 retake fee per attempt.
Most candidates pass on first or second attempt with adequate preparation. Failed first attempts typically reflect inadequate preparation or program-specific gaps in content coverage. Strong CAATE-accredited programs produce 80%+ first-time pass rates among their graduates.
Exam Preparation Strategy
Most successful candidates combine multiple study resources for BOC exam preparation. Common preparation tools include:
- BOC-published study guide and practice questions
- NATA review materials (Athletic Training Education Quizzes)
- Online review courses (ATexamprep.com, Mock BOC, NATA review courses)
- Practice question banks with detailed answer explanations
- Study groups with classmates from CAATE program
- Review of CAATE program comprehensive exam materials
Plan 4-8 weeks of dedicated study after master's program completion, with 20-30 hours per week of review. Most candidates dedicate substantial time to practice questions in the final 2 weeks before the exam to build test-taking endurance and identify weak content areas.
Application Timeline
Typical timeline from program completion to exam:
- Week 1-2: Submit application materials to BOC
- Week 2-4: BOC eligibility verification and approval
- Week 4-8: Schedule and prepare for exam at Pearson VUE testing center
- Week 8-12: Sit for exam, receive results within 4 weeks
Many graduates take the exam within 60-90 days of program completion. Some delay 4-6 months to extend study time, but most program directors recommend taking the exam relatively soon after graduation while content is fresh.
State Licensure After BOC
BOC certification is required for state licensure in 49 states (all except California). State licensure is a separate process from BOC certification — after passing the BOC exam, you apply for state licensure through your state's athletic training board or licensing authority. Requirements typically include:
- Active BOC certification verification
- State application and fee ($75-$300)
- Background check and fingerprinting
- State-specific jurisprudence exam (in some states)
- Documentation of supervised clinical hours during program
State licensure typically takes 1-3 months from application submission. Most candidates apply for licensure simultaneously with or immediately after passing the BOC exam.
Maintaining Certification
BOC certification requires renewal every 2 years. Renewal requirements include:
- 50 Continuing Education Units (CEUs) every 2 years
- Current CPR/AED certification
- $80 renewal fee
- Active practice or continued involvement in the profession
- Compliance with BOC Standards of Professional Practice
CEUs come from continuing education courses, conference attendance, professional articles, presentations, and other professional development. Most working ATs accumulate CEUs through routine professional engagement and employer-sponsored training. Common CE platforms include NATA member resources, MedBridge, and various specialty conferences.
Specialty Certifications and Advanced Practice
Beyond BOC certification, ATs can pursue specialty credentials that enhance practice and pay. Common specialty certifications include:
- Strength and Conditioning Specialist (CSCS) through NSCA
- Performance Enhancement Specialist (PES) through NASM
- Corrective Exercise Specialist (CES) through NASM
- Postural Restoration Institute (PRI) certifications
- Selective Functional Movement Assessment (SFMA)
- Functional Movement Screen (FMS)
- Manual therapy certifications (Maitland, McKenzie, Mulligan)
- Dry needling certification (state-dependent scope)
Specialty certifications typically cost $300-$2,000 plus exam fees and require ongoing CEU maintenance. Most career-track ATs pursue 2-3 specialty credentials in their areas of focus to support advancement to senior clinical positions or specialty practice.
What Happens If Certification Lapses
If your BOC certification lapses, you cannot practice as an athletic trainer in any state requiring BOC. Reinstatement requires either late renewal with additional fees and CEU documentation or, after extended lapses, retake the BOC exam. Most states also suspend AT licensure when BOC certification lapses. Maintaining timely renewal is essential for continued practice.
For oveoverall career path, see How to Become an Athletic Trainer. For salary by setting, see Athletic Trainer Salary by Setting.
Frequently Asked Questions
How hard is BOC exam? Pass rate ~75-80% for first-time takers from accredited programs. Comprehensive exam covering injury prevention, evaluation, immediate care, treatment, rehabilitation, professional responsibility. Strong preparation through accredited program plus practice exams essential.
What's BOC exam format? Computer-based, 175 multiple-choice items, 4 hours. Adaptive testing format. Cost $400 (member) / $470 (non-member).
BOC renewal requirements? Annual renewal requires 50 CEUs every 3-year reporting period plus annual fee ($150). Most career-track ATs maintain BOC continuously.
Best CE sources? NATA (National Athletic Trainers' Association) annual conference (worth 25-30 CEUs), NATA online courses, BOC-approved providers, sports medicine conferences.
Multi-state licensure? Most states have reciprocity through BOC certification. Some states (especially major sports states) may require state-specific application plus jurisprudence exam.
What if BOC certification expires? Reinstatement requires CE catch-up plus reinstatement fee. Most career ATs maintain certification continuously.
Specialty BOC certifications? No — BOC offers single primary credential. Specialty practice through clinical experience plus voluntary specialty designations (CSCS for strength and conditioning, etc.).
How does BOC compare to PT licensure? Different professions and different regulatory bodies. Some states allow ATs to practice independently; others require physician supervision. PT direct access broader nationally.
Where can I verify these salary figures? See U.S. Bureau of Labor Statistics OEWS data for Athletic Trainers for current state, metro, and industry pay statistics.