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(Optional) Field-Validated Expertise Areas
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All Providers
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Please provide a minimum of three (up to a maximum of six) recent references that are representative of your work in EACH expertise area. If possible, do not duplicate references or list CDE staff as references. Each expertise area is a content-specific reference survey. Listing a reference more than once will generate multiple surveys. CDE will remove references if a given individual is set to receive more than two reference surveys. Please note that for Field-Validated Expertise Areas, a minimum of three COMPLETED references surveys are needed for validation. If the number of references is of concern, consider limiting the number of expertise areas.
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Expertise Area (up to three)Reference Contact NameReference Contact Email AddressReference Contact Phone NumberReference Contact TitleRelationship to Applying Provider
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Expertise Area 1
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Reference #1 (required)
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Reference #2 (required)
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Reference #3 (required)
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Reference #4 (optional)
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Reference #5 (optional)
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Reference #6 (optional)
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Expertise Area 2
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Reference #1 (required)
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Reference #2 (required)
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Reference #3 (required)
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Reference #4 (optional)
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Reference #5 (optional)
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Reference #6 (optional)
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Expertise Area 3
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Reference #1 (required)
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Reference #2 (required)
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Reference #3 (required)
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Reference #4 (optional)
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Reference #5 (optional)
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Reference #6 (optional)
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