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ACPE ACCREDITATION COMMISSION
REGIONAL REVIEWER REPORT TO ADD A SATELLITE PROGRAM OR COMPONENT TO ACCREDITED MEMBER
Submission Date: _______________
Region: ____________________
Satellite Program Center: _______________________________________________________
Satellite Program Supervisors: ___________________________________________________
Address: _____________________________________________________________________
Accredited Member Host Center: ________________________________________________
Supervisors at Accredited Member Host Center: ____________________________________
Types of programs: CPE Level I /Level II _____ Supervisory CPE _____
Evaluation of Materials:
1. Material Submitted
_____ 1.1.Written request to add a Satellite Program
_____ 1.2. Accreditation Review Request and Face Sheet (2016 Accreditation Manual Appendix 3)
_____ 1.3.Copy of Satellite Program agreement/contract
_____ a. Delineates educational and administrative mechanisms of relationship
_____ b. Includes delineation of Supervisory Involvement of Training Supervisor if Satellite Program employs/contracts a Supervisory Candidate or SES
_____ c. All needed signatures present
_____ 1.4. History of CPE at Satellite Program site
_____ 1.5. Satellite Program Specific Student Handbook
_____ 1.6. Specific Handbooks of Clinical/Educational Placements (include copies of agreements)
_____ 1.7. If to be listed in ACPE Directory:
_____ a. Site Visit scheduled for _________________________
_____ b. Accreditation Review Request and Face Sheet (2016 Accreditation Manual, Appendix 3)
_____ c. Copy of Regional Accreditation Committee’s recommendation and file of material (to include: site visit report verifying compliance with ACPE Standards, Satellite Program agreement/contract, and satellite program specific student handbook(s),
_____ d. copy of Clinical Placement Handbook Materials and Agreements (if any clinical placement sites), Copy of the Regional Reviewer Report
2. Summarize Request for Addition of a Satellite Program
3. Date Provisional Status given: __________________
4. Evaluate if Satellite Program agreement or contract is in compliance.
5. Evaluate if the Student Handbook is in compliance.
6. Identify requests for additional information from Accredited Member Center, if any, and describe Accredited Member Center’s response to request for additional information.
7. Additional critique and/or recommendations.
8. Regional Committee recommendation:
8.1. Grant addition of Satellite Program with or without recommendations or notations.
8.2. Deny request to add a Satellite Program.
Reviewers: ____________________________ ______________________________
Date: ____________________________