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  • Read carefully before submitting:

    • - All questions must have complete and accurate answers to be considered.
    • - Answers should be concise but thorough.
    • - Write out acronyms.
    • - Submit only one application.
    • - If possible, do not use a phone to complete the application.
    • - If you have any questions, please contact Lindsey Pertet at
  • MM slash DD slash YYYY
  • Either personal or professional. Email is the primary way you will be contacted about the course.
  • List all completed degrees and field of study or major(s).
  • List all that are related to health including license number if applicable.
  • Employer Information

    Include information on who employs you as a CCHC. If you are applying to practice as an independent CCHC (not employed by an agency as a CCHC), please enter "Independent" under "Employer" below. Your employer information is not needed.
  • Application Questions

  • Describe how becoming a CCHC will help you meet your current job responsibilities.