How to Become a Provider Overview

Physicians, 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.
To download:

1. For PCs, right click on the form or PDF link
2. From the pop-up menu that opens, select Save Link As (or Save Target As)
3. In the Save As dialog box, select the folder where you would like the file saved
4. For Macs, click the link to open and then save

Once the file is downloaded to your computer:

1. Go to the folder where you saved the file
2. Double-click the file to open the PDF
3. Print the form
4. Complete the form and return by mail

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