Peer Reviewer Application Applicant Information: Question Title * 1. Please enter your contact information: First and last name Email Address Phone Number Question Title * 2. BOC Number Question Title * 3. State License and Number Question Title * 4. NPI Number Question Title * 5. Highest Degree Obtained Question Title * 6. Discipline of Highest Degree Question Title * 7. Current Employment Setting Question Title * 8. Current Employer Question Title * 9. State of Employment Question Title * 10. Please select the program you are applying to be a Peer Reviewer for. Professional Programs Residency and Fellowship Programs Question Title * 11. Elaborate on why you are interested in volunteering and your experience with or understanding of CAATE accreditation standards. Question Title * 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. Question Title * 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 providerii. Current or past affiliation with the CAATEiii. Current or past affiliation with a CAATE-accredited program or a health care profession’s accredited program Question Title * 14. Please list three references with contact information. Reference 1 Reference 2 Reference 3 Required Uploads Question Title * 15. CV or resume Next
