Evaluation Review Panel

First Name*

Last Name*

Credentials*

Governing Organization/Employer*

Nursing Education Unit/Department*

Work State*

Home State*

ACEN-Accredited Nursing Programs*

Which nursing program type(s) is/are ACEN-accredited at your governing organization? (check all that apply)

Practical
Diploma
Associate
Baccalaureate
Master's
Clinical Doctorate
Not Applicable (Clinicians)

Nursing Program Experience*

Which nursing program types are do you have experience in, in the past 5 years? (check all that apply)

Practical
Diploma
Associate
Baccalaureate
Master's
Clinical Doctorate

Evaluation Review Panel Experience*

How many Evaluation Review Panels have you previously served on?

0
1 - 2
3 - 4
5+

Availability*

On which days will you be available to serve as an ERP Program Reviewer? (check all that apply)

A panel assignment may consist of 1-2 days. Tentative time of day is 9:00 AM - 4:00 PM Eastern Time.
Exact schedule will be confirmed at a later date.

Wednesday, January 19, 2022 (For Focused Visits)
Monday, January 24, 2022
Tuesday, January 25, 2022
Wednesday, January 26, 2022
Thursday, January 27, 2022
Not Available

Comments/Notes

Evaluation Review Panel – Reviewer Availability

REVIEWER AVAILABILITY FORM

Evaluation Review Panel Availability - January 2022