CHAMP Mentors are physicians, nurse practitioners, or physician assistants who have the combination of training and experience to be considered an expert in child sexual abuse. Mentors are active providers of child sexual abuse evaluations who practice in settings that allow them to train other medical professionals. Faculty are child abuse experts who want to be a child abuse resource but not train others in child sexual abuse examinations. Faculty may provide child sexual abuse evaluations or have a specific expertise related to child abuse.
The application process has these steps:
Submit a Mentor or Faculty application along with a current CV
Submit 3 letters of reference, with one being from a current or most recent supervisor
Submit documentation of American Board of Pediatrics certification for Child Abuse Pediatrics or record of successful completion of the CHAMP course Evaluating Child Sexual Abuse.
If you are applying to be a Mentor or child sexual abuse Faculty, you must also submit five of your most recent child sexual abuse cases for review. The review requires submitting photodocumentation as well as written information. The case review forms do not contain information that identifies the patient. Your cases will be reviewed by CHAMP Mentors who have been blinded to your identity. After you submit your application and supporting materials, Linda Markell will send you the case review forms.
After your cases have been reviewed, Linda Markell will forward all of your materials to the Application Committee of the CHAMP Advisory Board for consideration.
If you are approved to become a Mentor, you will be partnered with an experienced Mentor who will give you an orientation to providing mentorships and reviewing cases. After this orientation, you will be listed on the Roster of CHAMP Mentors and Faculty and your facility will be listed as a CHAMP Center of Excellence on the CHAMP website www.CHAMPprogram.com .
If you are approved to become Faculty, you will receive information about serving as CHAMP Faculty and be listed on the Roster of CHAMP Mentors and Faculty, which is posted on the CHAMP website www.CHAMPprogram.com .
Mentor and Faculty Applications
You can download a Mentor application (PDF) or Faculty application (PDF). You can also request that an application be mailed to you. If you need help with downloading or opening the PDFs, please see below.
If you have questions or need an application, please contact Linda Markell, CHAMP Manager. MarkellL@upstate.edu
Phone: 315-883-5615
Fax: 315-883-5616
HELP with the PDF forms
To view the PDF, you will need the free Acrobat Reader.
To fill out the form, please download the PDF document to your computer, print and fill it out, and return by mail.
To download:
For PCs, right click on the form or PDF link
From the pop-up menu that opens, select Save Link As (or Save Target As)
In the Save As dialog box, select the folder where you would like the file saved
For Macs, click the link to open and then save
Once the file is downloaded to your computer:
Go to the folder where you saved the file
Double-click the file to open the PDF
Print the form
Complete the form and return by mail
NOTE If you experience difficulties with downloading or opening the PDF, try downloading the file with Internet Explorer.
