On what date will the sponsoring institution obtain a binding commitment from the prospective resident(s)? Supplemental Materials The following items must be submitted on each flash drive (see page 1 of the report). Please refer to the referenced requirements in CPME 320, Standards and Requirements for Approval of Podiatric for further information specific to each required document. Medicine and Surgery Residencies, Sponsorship and Affiliation Agreements: Provide the following information for the sponsoring institution, including the sponsor and co-sponsor (if applicable), and each affiliated training site (e.g., hospital, surgery center, private practice office). For each institution identified below, provide copies of accreditation documents (e.g. Joint Commission and AAAHC) and copies of executed affiliation agreements between the sponsoring institution and the affiliates. Date Coordinator Affiliation City, Accredited Percentage Name Signed/ State By of Training Effective Date Staff? Name
On what date will the sponsoring institution obtain a binding commitment from the prospective resident(s)? Supplemental Materials The following items must be submitted on each flash drive (see page 1 of the report). Please refer to the referenced requirements in CPME 320, Standards and Requirements for Approval of Podiatric Medicine and Surgery Residencies, for further information specific to each required document. Sponsorship and Affiliation Agreements: Provide the following information for the sponsoring institution, including the sponsor and co-sponsor (if applicable), and each affiliated training site (e.g., hospital, surgery center, private practice office). For each institution identified below, provide copies of accreditation documents (e.g. Joint Commission and AAAHC) and copies of executed affiliation agreements between the sponsoring institution and the affiliates. Name City, State Accredited By Percentage of Training Date Affiliation Signed/ Effective Date Coordinator Staff? Name
CPME309ApplicationforProvisionalApproval-RevisedAugust2015.docx