For any programs that you are affiliated with, please indicate the following:
If you are a graduate, indicate the year you graduated. (Ex: NIP: 2010)
If you are a current student, indicate your current program year. (Ex: NIP: 3rd Yr)
If you are are advisor (Adv), faculty (F), or supervisor (S), please indicate this.
For ITP, indicate whether you are Trauma Affiliate (TA) or Trauma Certificate (TC). (Ex: ITP: TA)
For OYE, indicate whether you are clinical (C). (Ex: OYE: C 2nd Yr)
These indicators may be combined.
(Ex. 4-Year program graduate who is currently a Supervisor would indicate this - NIP: 1987 S)
Please list all health insurance plans you accept.
Type each one on a separate line if more than one is accepted.
Besides English, please list all languages you use in your practice.
Write one language per line.