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ACPE ACCREDITATION COMMISSION
REGIONAL REVIEWER REPORT TO ADD SUPERVISORY CPE
Submission Date: _______________ Region: ____________________
Accredited Member: ___________________________________________________________
Address: ____________________________________________________________________
Supervisors: ________________________________________________________________
Evaluation of Materials:
1. Check List: Material Submitted
_____ 1.1 Copy of Provisional Letter
_____ 1.2. Accreditation Review Request and Face Sheet (2016 Accreditation Manual, Appendix 3)
_____ 1.3. Written request to add supervisory CPE
_____ 1.4. Rationale for this new program
_____ 1.5. Congruence of proposal with mission/goals of the Accredited Member Center
_____ 1.6. Summary of Accreditation History of CPE at Accredited Member Center
_____ 1.7. Survey of prospective student enrollment
_____ 1.8. Provision for additional faculty, financial and support resources
_____ 1.9. Complete CPE Supervisory Student Handbook/Sections of master Student Handbook
_____ 1.10. Compliance of Student Handbook and other materials with ACPE standards
_____ 1.11. Detailed curriculum in compliance with Standards and Certification Manual
_____ 1.12. Specific Manual(s) for any Clinical Placement(s)/Educational Placement(s)
_____ 1.13. copy of Clinical Placement Agreements
_____ 1.14. copy of Educational Placement Agreements
_____ 1.15. Copy of Supervisory Student agreement(s)/contract template(s)
_____ 1.16. delineation of Supervisory Involvement of Training Supervisor
_____1.17. delineation of administrative/educational mechanisms by which the Supervisory Education Student is related to the Accredited Center and the Training Supervisor(s)
_____ 1.18. information about benefits, stipend, responsibilities, etc.
2. Summarize Request for Addition of Supervisory CPE
3. Evaluate Supervisory Program contract(s) for compliance
4. Evaluate the Supervisory Handbook or Section in the Master Handbook for compliance.
5. Evaluate the Supervisor CPE Curriculum for compliance
6. Identify requests for additional information from center.
7. Describe Center’s response to request for additional information.
8. Include additional critique and/or recommendations.
9. Provide regional committee recommendation:
9.1. Add Supervisory CPE with or without recommendations or notations, or
9.2. Deny request to add Supervisory CPE.
Reviewer(s):
Date: