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  • Read carefully before submitting:

     
    • - All questions must have complete answers to be considered.
    • - Answers must be clear, concise, accurate, and thorough.
    • - Write out acronyms.
    • - Application should be submitted one time. Only one application will be considered.
    • - If possible, do not use a phone to complete the application.
  • 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.
  • If you are self-employed or plan to work independently, please write independent.
  • Application Questions

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