The AHFSA Surveyor Registry
The AHFSA Surveyor Registry has been created for retired surveyors who are interested in continuing in the surveyor field post retirement. The intent of this registry is to assist State Agencies by supplementing the state workforce and to meet the mission and priorities document expectations. Information collected is not shared outside of AHFSA. Surveyors who subscribe to the registry understand that their information will be accessible to all state agencies who access the registry.
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Email *
Surveyor Full Name *
Who was your State Agency employer? *
Dates of service? *
Name and contact email of former supervisor? *
Do you give permission to contact your former supervisor? *
SMQT certified? *
What provider types are you interested in surveying *
Required
If you listed "other" as a facility type, please include that facility type here.
What is your date of availability? *
MM
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DD
/
YYYY
What state(s) are you interested in surveying? *
List your professional credentials.
Include any other information you feel is valuable in consideration of your availability to survey.
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