Submit Digital Forms

Recommended if applying to Liberia National Physician Assistants Association & Board

CPD Provider Registration Form

Name of CPD Provider

Contact Person

Job Title of Contact Person

Phone Number of Contact Person

Email Address of Contact Person

Physical Address of Contact Person

Website

If outside of Liberia, name of partner organization in Liberia

In which counties do you plan to provide CPD?

Other, please describe:

Submit the below documents by email:

[Required] Business registration or equivalent documentation (e.g. Council of Higher Education accreditation, MOH Sectoral Clearance, articles of incorporation, etc.). For organizations outside of Liberia, include documentation for both the CPD provider and partner organization in Liberia.

[Optional] Training plan, including course topics and description of target audience

[Optional] For registration renewals, reports or evaluations from previously-delivered CPD courses

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