ACPAC Program

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ACPAC 2020-2021 Program Application

Name*

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Address*

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How did you hear about the ACPAC program?*

Institution / Workplace Details

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Professional Information

Institution from which Professional Degree was issued

Professional Designations

Year of Graduation

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Institution / Workplace

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Prerequisites

Please indicate which of the following prerequisite courses you have completed:

Clinical Practice Skills for Inflammatory Arthritis (CPSIA) program offered by the Arthritis Society

Date CPSIA program completed

Assessment and Management of Rheumatic Diseases: A skills workshop offered by the ACE Program

Date Assessment and Management of Rheumatic Diseases completed

An equivalent course to the above

Equivalent course name and date completed

None of the above

CPSIA Course

I have registered for an upcoming CPSIA course

ACPAC 2020-2021 Program Application

Institution / Workplace Details

Professional Information

Primary Administrative Contact

Prerequisites

Locations