Applicant Information:

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1. Please enter your contact information: (Required.)

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2. BOC Number (Required.)

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3. State License and Number (Required.)

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4. NPI Number (Required.)

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5. Highest Degree Obtained (Required.)

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6. Discipline of Highest Degree (Required.)

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7. Current Employment Setting (Required.)

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8. Current Employer (Required.)

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9. State of Employment (Required.)

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10. Please select the program you are applying to be a Peer Reviewer for. (Required.)

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11. Elaborate on why you are interested in volunteering and your experience with or understanding of CAATE accreditation standards. (Required.)

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12. Describe how you will ensure respect for institutional autonomy, quality assurance standards, and inclusion are integrated into your practices, roles and/or responsibilities as a peer reviewer. (Required.)

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13. Individuals should have experience in one of the following areas and elaborate on that experience (exceptions require Commission approval):

i. Evidence of experience as a healthcare provider

ii. Current or past affiliation with the CAATE

iii. Current or past affiliation with a CAATE-accredited program or a health care profession’s accredited program (Required.)

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14. Please list three references with contact information. (Required.)

Required Uploads

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15. CV or resume (Required.)

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