TERM Applications
Instructions
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Form W-9 (Rev. December 2014)
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Request for Taxpayer Identification Number and Certification | 2017-11-02 |
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Instructions_and_FAQs_Credentialing_and_Contracting (pdf)
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2022-04-05 | |
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TERM Panel Specialty Criteria (pdf)
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Revised 10/11/2021 | 2021-10-19 |
Credentialing Application
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1.1 Credentialing Criteria (pdf)
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2020-01-30 | |
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Credentialing Application Instructions (pdf)
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2020-02-26 |
TERM Therapist Applications
| TERM Therapist Clinical Application (docx) | Revised 02/01/2023 | 2023-03-02 |
| Writing Sample Packet for Therapist (pdf) | 2024-10-17 |
TERM Evaluator Applications
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TERM Evaluator Application (docx)
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2023-04-26 | |
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Writing Sample Packet for Evaluators (pdf)
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2024-09-12 |
Interns
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Evaluator Intern Packet (docx)
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2018-08-29 | |
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Therapy Intern Application (docx)
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2018-08-29 |
Specialty Addition Applications
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TERM Evaluator Specialty Addition Application (docx)
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Revised 02/01/2023 | 2023-03-02 |
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TERM Therapist Specialty Addition Application (docx)
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Revised 02/01/2023 | 2023-03-02 |