Provider Name text - 50 characters maximum Name under which institution, organization, or individual operates as a provider of training services. Provider should enter the date on which this application was submitted. Type of Organization select from list Choose as many as apply.
Provider can select more than one choice from list.
Specialty areas drop down list Select up to 3 choices from the list. All providers must supply their nine-digit Federal Tax ID to ensure consistency in the system. Social Security number may be substituted for individual or sole proprietorships. If provider is accredited, specify name of accrediting agency. Types of Offerings select from list Provider may choose as many as apply.