TERM Applications

Instructions

Instructions and FAQs Credentialing and Contracting (pdf)
Revised 02/06/2020 2020-02-10
TERM Panel Speciality Criteria (pdf)
2018-06-22
W9 Form (pdf)
2017-11-02

Credentialing Application

1.1 Credentialing Criteria (pdf)
2020-01-30
Credentialing Application (docx)
2019-05-07

TERM Therapist Applications

TERM Therapist Clinical Application (docx)
Revised 02/10/2020 2020-02-10
Writing Sample Packet for Therapist (docx)
2018-07-12

TERM Evaluator Applications

TERM Evaluator Clinical Application (docx)
Revised 02/10/2020 2020-02-10
Writing Sample Packet for Evaluators (pdf)
2018-07-10

Interns

Evaluator Intern Packet (docx)
2018-08-29
Therapy Intern Application (docx)
2018-08-29

Specialty Addition Apllications

TERM Evaluator Specialty Addition Application (docx)
2019-03-08
TERM Therapist Specialty Addition Application (docx)
2018-07-11