CTP Questionnaire

Market *

NATIONAL CAPITAL REGION Facility *

SAN DIEGO Facility *

PUGET SOUND Facility *

SAN ANTONIO Facility *

TIDEWATER Facility *

AUGUSTA Facility *

JACKSONVILLE Facility *

COASTAL MISSISSIPPI Facility *

SACRAMENTO Facility *

ALASKA Facility *

CENTRAL NORTH CAROLINA Facility *

COLORADO Facility *

SOUTHWESTERN KENTUCKY Facility *

SOUTHWEST GEORGIA Facility *

CENTRAL TEXAS Facility *

EL PASO Facility *

FLORIDA PANHANDLE Facility *

NORTH CAROLINA COAST Facility *

LOW COUNTRY Facility *

KANSAS Facility *

GARDEN STATE Facility *

UPSTATE NEW YORK Facility *

CENTRAL SOUTH CAROLINA Facility *

CENTRAL OKLAHOMA Facility *

OZARKS Facility *

CALIFORNIA DESERT Facility *

CENTRAL LOUISIANA Facility *

CORPUS CHRISTI Facility *

LOS ANGELES Facility *

CENTRAL KENTUCKY Facility *

CENTRAL VIRGINIA Facility *

GREAT LAKES Facility *

LAS VEGAS Facility *

LITTLE ROCK Facility *

NEW ENGLAND Facility *

WEST POINT Facility *

STAND-ALONE MTFS Facility *

GUAM MARKET Facility *

HAWAII MARKET Facility *

OKINAWA MARKET Facility *

JAPAN MAINLAND MARKET Facility *

KOREA MARKET Facility *

GERMANY/BELGIUM MARKET Facility *

NORTHERN ITALY MARKET Facility *

SOUTHERN ITALY/ GREECE/TURKEY/BAHRAIN MARKET Facility *

SPAIN/PORTUGAL MARKET Facility *

UNITED KINGDOM MARKET Facility *

CTP Courses covered under Agreement (MOA/MOU) by Program Name (e.g., Radiology, LPN, Physical Therapy, etc.) *

Do you have a MOA/MOU for CTP training? *

Yes

MOA/MOU Upload

Attach current copies of Signed or Draft agreements. Label files with the "CTP" prefix, the market/facility name, and if the agreement is signed or in draft format. (e.g., CTP_TAMC CTP MOA 2015 signed, or CTP_NML&PDC TOPS MOA 2021 DRAFT).
Files must be less than 1 GB.
Allowed file types: gif jpg jpeg png bmp eps tif pict psd txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml bz2 dmg gz jar rar sit tar zip.

When was your MOA/MOU signed? *

Month

Day

Year

When will your MOA/MOU Expire? *

Month

Day

Year

When will your MOA be ready for signature/approval? *

Month

Day

Year

Current Point of Contact for Agreement

Program Director, Clinical Training Coordinator, or Support Agreement Manager.

Name *

Email *

Phone Number *

Current Alternate Point of Contact for Agreement

Program Director, Clinical Training Coordinator, or Support Agreement Manager.

Name

Phone Number

General Comments

Leave this field blank

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