Accreditation Program Assessor Application

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The information on this form is collected under the authority of section 5-21 of the Bylaws under the Health Professions Act, RSBC 1996, c.183. If you have any questions about the collection and use of this information, please contact the College at 300–669 Howe Street, Vancouver BC V6C 0B4 or by phone at 604‐733‐7758 or 1‐800‐461‐3008 (toll‐free in BC).

Applicant information

Name: (as it appears on driver's licence or passport)

*Given name(s):

*Last name:

*Credentials:
Select the program you are applying to be an assessor for and then select your credentials.

*Diagnostic Imaging (check all that apply):

MD
RTR
RTNM
RDCS
CRVS
RTMR
RDMS
CRGS
CRCS
Other:

*Laboratory Medicine (check all that apply):

MD
PhD
RT
ART
Other:

*Neurodiagnostics (check all that apply):

MD
FRCPC
RET
REPT
EPT
RTEMG
Other:

*Polysomnography (check all that apply):

MD
RPSGT
CPSGT
HSAT
Other:

*Pulmonary Function (check all that apply):

MD
FRCPC
RRT
CACPT
Other:

*Non-Hospital Medical and Surgical Facilities Accreditation Program (check all that apply):

Surgeon
Anesthesiologist
Registered nurse
Medical device reprocessing technician or equivalent
Clinical embryology/andrology