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SOMB Provider Applications – Skin App Free Adult APK

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For New Providers – Associate Level

  1. You must complete a fingerprint process and background check. Fee is $49.50
    • NEW process effective 9/24/2018 To request information about the fingerprint process, contact Jill Trowbridge at jill.Trowbridge@state.co.us or 303-239-4526. 
  2. Fill out ​APPLICATION 1 – FIRST APPLICATION FOR ASSOCIATE LEVEL (PDF) — For Associate Level Treatment Provider and/or Evaluator
  3. Complete the following competency-based forms and assessments based on the type of listing you are applying for. Read the Competency Assessment Summary (PDF) for additional guidance.

For Providers Who Want to Add an Additional Status 

  1. Fill out ​APPLICATION 1 – FIRST APPLICATION FOR ASSOCIATE LEVEL (PDF) — For Associate Level Treatment Provider and/or Evaluator
  2. Complete the following competency-based forms and assessments based on the type of listing you are applying for. Read the Competency Assessment Summary (PDF) for additional guidance.

Applications For Existing Providers

  1. Fill out the appropriate application:
    1. Providers who have completed their first year listing and are ready to apply for their initial 3 year listing
    2. Providers ready to move to Full Operating Level prior to their renewal date (including DD/IS Specialty) or applying for Clinical Supervisor Status.
    • APPLICATION 3 – RENEWAL OF CURRENT LISTING — This application is used for the following:
      1. For associate and Full Operating Level Treatment Provider, Evaluator, and/or Clinical Supervisor applying to continue their status after their initial 3-year listing 
  2. Submit the $125 application fee by check, money order or cashier’s check made out to the Colorado Department of Public Safety (not required if you are applying to change a status prior to your renewal date).
  3. Complete the following competency-based forms and assessments based on the type of listing you are applying for. Read the Competency Assessment Summary (PDF) for additional guidance.

For Polygraph Examiners

Please use the following forms to apply, re-apply, move up to full operating level, and/or comply with quality assurance requirements.

***Review your information on the Provider List for accuracy and submit the CHANGE OF INFORMATION FORM if your information is out-of-date and needs to be updated. Please take this step, as numerous emails are being returned to us as undeliverable.

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