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BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY GAVIN NEWSOM, GOVERNOR Board of Vocational Nursing and Psychiatric Technicians 2535 Capitol Oaks Drive Suite 205, Sacramento, CA 958332945 Phone 9162637800.

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How to fill out the VERIFICATION OF FACULTY QUALIFICATIONS FORM online

This guide provides clear and comprehensive instructions on how to complete the Verification of Faculty Qualifications Form online. Following these steps will ensure that you accurately submit the required information for faculty qualifications assessment.

Follow the steps to complete the form correctly.

  1. Press the ‘Get Form’ button to acquire the form and open it in your digital workspace.
  2. Begin by entering the program or school name as requested in the designated field.
  3. Select the type of program you are completing this form for by checking one of the options: VN Program or PT Program.
  4. Fill in the full name of the faculty applicant, ensuring it matches the name on their license.
  5. Choose one position title from the options provided: Director, Assistant Director, Instructor, Additional Faculty, or Teacher Assistant.
  6. Indicate the teaching assignment by checking all applicable boxes for full-time or part-time status and the type of teaching. Select whether you are teaching theory or clinical sessions.
  7. If you are the Director, provide the position effective/start date.
  8. Complete the professional license information section by entering details about California RN, LVN, or PT licenses, including expiration dates.
  9. In the faculty teaching qualifications section, check all applicable qualifications and attach the necessary documents to verify compliance with the relevant California Code of Regulations.
  10. Directors and Assistant Directors must confirm attached documents related to required course completion by checking the appropriate boxes.
  11. For additional faculty, check the curriculum courses to be taught and ensure compliance by checking required qualifications.
  12. Teacher assistants must read and check the box confirming understanding of their required supervisory relationship.
  13. Provide details of professional experience as an RN, LVN, or PT, noting the duration and duties performed.
  14. Include your teaching experience, specifying the institution, role, and type of instruction provided.
  15. Certify the information provided by signing and dating the application. Include your contact information and that of the program director.
  16. Once all fields are completed, save your changes, and download, print, or share the completed form as necessary.

Complete your documents online today to ensure a smooth submission process.

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VERIFICATION OF FACULTY QUALIFICATIONS FORM
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2019 CA 55M-10
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  • 2019 CA 55M-10
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