Champ Program Child Abuse Medical Provider Program Education for Child Abuse Medical Providers, CHAMP Program, www.champprogram.comHome CHAMPMember AreaCourseworkSkip navigation, go to content directlybackground
spacer CHAMP Home PageWhats NewAbout us CHAMP Network Who is a Child Abuse Expert?CHAMP Mentors and FacultyCHAMP Centers of ExcellenceRoster of CHAMP Mentors and FacultyCriteria for MentorsMentor and Faculty Application ProcessCHAMP ProvidersList of CHAMP ProvidersHow to become a CHAMP ProviderTraining to a CHAMP ProviderExpedited Application for Provider Status Requirements for Providers to Remain in the CHAMP Network Coursework Educational Resources for Medical ResidentsPractice RecommendationsResources for Professionals DOH Initiatives Contact UsSitemap  

CHAMP Network


Application Process for Mentors and Faculty

  • Application for Mentor  PDF
    If you need help with downloading/opening PDFs, please see below
  • Application for Faculty   PDF

List of CHAMP Providers

How to Become a CHAMP Provider



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
NOTE If you experience difficulties with downloading or opening the PDF, try downloading the file with Internet Explorer.