There are three requirements for FM CORE Master Instructor (MI) status:
1. Certification as FM CORE IP
2. A point for each Questions #5,6,7,8,9.
3. A reference from a Master Instructor in Question #10.

Applications are processed within 30 days.
Asterisk denotes answer required.

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* 1. Please enter date:

Date

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* 2. Please enter your name:

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* 3. Please identify your profession:

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* 4. Please enter your IP Number:

You must answer affirmative for each Question #5,6,7,8,9 in order to be certified as a FM CORE MI and proceed to the next question.

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* 5. Please confirm that:
(1 point)

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* 6. Have you taught at least two CPoCUS/non-CPoCUS accredited CORE courses or taught individuals? Please list name and date of courses.
(1 point)

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* 7. Have you given the CPoCUS FM CORE exams (Written, Visual, Practical) three or more times?
(1 point)

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* 8. Have you provided 40 or more hours of FM CORE IP training in the past year?
(1 point)

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* 9. Are you competent in the use of and ability to teach pelvic scanning?
(3 points)

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* 10. Please provide a short reference from a CORE Master Instructor.

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* 11. Attach additional material (if applicable).

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 12. Attach additional material (if applicable).

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 13. Attestation:

T