Register as a Provider

Interested in becoming a Registered Provider of the NASPA Pharmacy-based Test & Treat National Certificate Program? Please complete the form below and we will contact you shortly.

Questions? Please email education@naspa.us.

New Provider Request – NASPA Pharmacy-based Point-of-Care Test & Treat National Certificate Program

Please submit this form if you are interested in serving as a hosting organization for the NASPA Pharmacy-based Point-of-Care Test and Treat National Certificate Program.

Contact Information
Name*
First Last
Email*
Organization*
Who do you intend to train?*
(i.e., students, pharmacists at your organization, pharmacists in your community, etc.)
How many individuals do you plan on training annually?*
Trainer Information
The 20-hour certificate program is composed of 2 parts, the home study and the live session. The home study is 16 hours and can be completed asynchronously. The live session is 4 hours and must be led by an instructor/trainer.
Have you identified a trainer for the course?*
Please note: NASPA requires 1 trainer for every 16 participants.
- Yes
- No
In order to serve as a trainer for the program you must have: 1. Successfully completed the NASPA Pharmacy-Based Point-of-Care Test &Treat National Certificate Program. 2. Participated in and successfully passed the NASPA Train-the-Trainer course, and agree to follow all trainer requirements.
Do you understand the requirements listed above?*
- Yes
- No
Will you need the services of a NASPA-certified trainer for your trainings?*
Please note: There is an additional cost for trainer services.
- Yes
- No
If approved as a Registered Provider, when do you plan on hosting your first training?*
Any additional questions or comments?

New Provider Request – NASPA Pharmacy-based Point-of-Care Test & Treat National Certificate Program

Contact Information

Trainer Information