How to Become a Provider OverviewPhysicians, nurse practitioners, and physician assistants with pediatric experience who are currently practicing in New York State and hold a valid New York State license are eligible to become CHAMP Providers. There are two ways to become a CHAMP Provider. 1. Traditional
Most medical professionals use this method. Learn more about this process. 2. Expedited
Experienced practitioners who have done a minimum of 100 child sexual abuse examinations within the last 3 years can apply to become a CHAMP Provider. Learn more about this expedited process for Provider status or download an Expedited Provider application (PDF).
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.