Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in the appropriate editor.
2. Input the APRN name in the designated field and include the Delaware license number if applicable.
3. Provide the name of the collaborator in the specified area.
4. Enter the business or practice name in the corresponding section.
5. Fill in the location address of the main practice. Ensure no PO Box is used.
6. Complete the collaborator's phone number and email address fields.
7. Select the appropriate professional licensure type by checking the relevant box (Physician, Podiatrist, Other) and provide the license number and specialty.
8. Indicate the type of business or practice where the collaborative agreement occurred by checking all applicable options.
9. Check the APRN role for which you served as collaborator and select the relevant population focus area if applicable.
10. Enter the total hours of APRN clinical practice and the time period during which this practice occurred.
11. Confirm the APRN's competency by selecting 'Yes' or 'No'.
12. Finally, provide your signature and date to certify the accuracy of the form.
13. Once completed, save your changes, download, print, or share the form as needed.

Complete your DE Verification Of Experience And Competency form online today!