Request for Accreditation Services


OPTION 1 – Electronic Submission (This requires the CEO/President to type his/her name in the CEO Signature field prior to submission)

  • Complete all required fields in the form
  • Click “Submit” and a copy of the form will be emailed to the appropriate Committee on Accreditation and the email address entered for the “Individual completing this form”

OPTION 2 – Manual Submission

  • Click “Blank Printable Version” button located above the form below.
  • Print the form and complete all required fields manually
  • Mail/fax/email the completed, signed form to the appropriate Committee on Accreditation (contact information for submission appears at the top of the form)
Blank Printable Version
 
*Denotes Required Field(s)
This form will be submitted to:
Robin Seabrook
Executive Director
330 John Carlyle Street
Suite 200
Alexandria,VA 22314
Phone:(703) 836-7114
Fax:(703) 836-0838
Email:rseabrook@ncope.org
Institution Information
Profession: * Orthotic and Prosthetic Technician
This is a request for: *
Institution Name: *
Institution City: *
Institution State/Province: *
Institution Website: *
Institution Type: *
Institution Control: *
Name of INSTITUTIONAL accrediting agency: *
Type of award? (indicate all that apply): *

CAAHEP defines a distance education program as a program that allows completion of the entire curriculum without the need to attend any instruction on a campus location (clinical rotations excluded). Note: this delivery is not hybrid or partial e-learning delivery.

Is the program a distance education program?: *
Indicate all that apply
Describe the distance learning: *
Program Length (months): *
List month(s) classes begin each year: *
Month the program began: *
Year the program began: *
Where did you hear about CAAHEP accreditation?:
Program Director
First Name: * Last Name: *
Credentials: * Title: *
Institution Name: * Address: *
Address 2: Address 3:
City: * State/Province: *
Zip Code: * Phone: *
Fax: Email: *
Dean
First Name: * Last Name: *
Credentials: * Title: *
Institution Name: * Address: *
Address 2: Address 3:
City: * State/Province: *
Zip Code: * Phone: *
Fax: Email: *
Medical Director/Advisor
First Name: * Last Name: *
Credentials: * Title: *
Institution Name: * Address: *
Address 2: Address 3:
City: * State/Province: *
Zip Code: * Phone: *
Fax: Email: *
CEO
First Name: * Last Name: *
Credentials: * Title: *
Institution Name: * Address: *
Address 2: Address 3:
City: * State/Province: *
Zip Code: * Phone: *
Fax: Email: *
Individual Completing this form
Name: *
Working Title: *
Email: *
Phone: *
CEO Authorization
CEO Signature: *
By entering my name above, I attest that I am the CEO and that I have authorized initiation of the accreditation process. In addition, by entering my name above, I consent to the use of this electronic method of contract acceptance under the U.S. Electronic Signatures in Global and National Commerce Act (E-Sign); and I have read and agree to the terms and conditions in CAAHEP Copyrights and Permissions.
Date: 6/21/2018
 

If you wish to submit this form electronically please click the submit button below. Your Request for Accreditation Services will be forwarded to the appropriate Committee on Accreditation.

If you wish to submit this form by mail please click the print button below.


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