Faculty Information Requirements for Approval of NATCEP 42 CFR §483.152 Provide the following information for all faculty involved in the program since the last on-site compliance review. Under the column indicate either: Primary Instructor (PI), Co-Primary Instructor (CPI), Assistant Instructor (AI), or “Position” Resource Instructor (RI). Enter dates as 00/00/00. Date of Criminal License Date Date of Last History Record Date of Last Name Position License # Expiration Approved Faculty Information Mantoux Date by PDE Evaluation Report Years of Number of Experience in NATCEP Objectives Instructed by Resource Name of Resource Instructor(s) Credential of Area of Instructor Instruction Expertise Duplicate this page if needed *
Faculty Information Requirements for Approval of NATCEP 42 CFR §483.152 Provide the following information for all faculty involved in the program since the last on-site compliance review. Under the “Position” column indicate either: Primary Instructor (PI), Co-Primary Instructor (CPI), Assistant Instructor (AI), or Resource Instructor (RI). Enter dates as 00/00/00. Name Position License # License Expiration Date Date Approved by PDE Date of Last Faculty Evaluation Date of Criminal History Record Information Report Date of Last Mantoux Name of Resource Instructor(s) Credential Years of Experience in Area of Expertise NATCEP Objectives Instructed by Resource Instructor Number of of Instruction * Duplicate this page if needed
Self-Study%20Monitoring%20Booklet.docx