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)
Diagnostic Imaging
Laboratory Medicine
Neurodiagnostics
Polysomnography
Pulmonary Function
Non-Hospital Medical and Surgical Facilities Accreditation Program
MD
RTR
RTNM
RDCS
CRVS
RTMR
RDMS
CRGS
CRCS
Other:
MD
PhD
RT
ART
Other:
MD
FRCPC
RET
REPT
EPT
RTEMG
Other:
MD
RPSGT
CPSGT
HSAT
Other:
MD
FRCPC
RRT
CACPT
Other:
Surgeon
Anesthesiologist
Registered nurse
Medical device reprocessing technician or equivalent
Clinical embryology/andrology