1. 1. The chief medical officer’s name, mailing address, and telephone number;
2. 2. The name and address of the training program and of each facility where training will be conducted;
3. 3. The name, professional degree, license number, and licensing agency for each physician who will be providing supervision in the training program; and
4. 4. A mission statement outlining the goals of the training program.

A chief medical officer applying on behalf of a school of naturopathic medicine for a certificate to conduct clinical training, or on behalf of a preceptorship training program, shall submit to the Board the fee indicated in R4-18-107 and an application form provided by the Board, signed and dated by the chief medical officer, that contains:

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3702, effective August 9, 2002 (Supp. 02-3).