Confidential when completed
Program request for accreditation
submitted to the
Canadian Medical Association
Committee on Program Accreditation
c/o 8872147 Canada Inc., a CMA subsidiary
Revised by CMA Accreditation January 2014
Program request for accreditation
2
The registered trademarks of the Canadian Medical Association are used under license.
Program request for accreditation
i
Name of program: ________________________________________________________________________________
Designated health science profession: ________________________________________________________________
Educational level:
Assessment requested:
 Certificate
 Diploma




 Baccalaureate degree
 Masters’ degree
 Other (specify)
First assessment of program with graduates
First assessment of program without graduates
Reassessment of accredited program
Reassessment of unaccredited program
Corporate authority for program:
 Single corporate authority (i.e., one institution)
Name and address of institution (i.e., contact site) ___________________________________________
_______________________________________________________________________________________
or

Joint corporate authority (i.e., more than one institution) (page iii must be completed)
Name and address of contact site _________________________________________________________
_______________________________________________________________________________________
Name(s) and address(es) of other institution(s) _______________________________________________
________________________________________________________________________________________
Program’s intellectual property (curriculum, courses, etc.):
 owned by the program
 owned by ____________________________________________
___________________________________________________
Name of entity that holds the rights to the intellectual property
Program’s website(s): ______________________________________________________________________________
Program’s contact person*:
Name ______________________________________
Title___________________________________
Address _________________________________________________________________________________
Telephone _______________________ Fax ______________________ Email ________________________
Program sites:
Didactic delivery site(s)
_________________________________________________________________
__________________________________________________________________________________________
Program request for accreditation
ii
Clinical or practicum site (s): attach list of all sites
*
The person named as the contact for the program will receive all accreditation correspondence, reports and other communications,
and is expected to provide liaison between the accreditation secretariat and all partner sites.
Corporate authority’s request and agreement regarding program accreditation
The submission of this Program self-assessment report constitutes an agreement for accreditation services
between the Canadian Medical Association (CMA) and the program’s corporate authority. It signifies that the
undersigned administrator*, on behalf of the program’s corporate authority, hereby requests the Committee on
Program Accreditation assess the program for compliance with the Requirements for accreditation according to
the procedures described in the Program assessment procedures. It also signifies a commitment by the
program’s corporate authority to the values of the accreditation process including peer review, and an
agreement to comply with all requirements for accreditation on an ongoing basis.
By this request, the administrator agrees to notify all personnel involved in student education and evaluation at
all sites that samples of student evaluation records (with student names removed or student releases signed),
and information on involved personnel with regard to their role in the program will be provided by the
program to survey teams during the accreditation process.
CMA shall periodically review the Requirements for accreditation and Program assessment procedures and make
any changes considered necessary. CMA shall provide the program with revised documents in a timely fashion
and the program will accept and comply with any and all changes.
This agreement also acknowledges that the program’s accreditation status accorded by the Committee on
Program Accreditation will be disclosed on the Official list of programs published on www.cma.ca/accredit. The
details of a program’s assessment, including a copy of the Program assessment report, may be disclosed to a
professional regulatory authority that has legal obligations with respect to the quality of educational programs
for a particular profession, provided that this regulatory authority has an agreement with CMA for accreditation
services. In no other circumstance will the details of a program’s assessment be disclosed to a third party
without the consent of the program.
CMA shall indemnify and hold harmless the corporate authority, its directors, officers and employees against
any claims, demands, losses or damages arising out of the negligent provision of accreditation services. The
corporate authority shall indemnify and hold harmless the CMA, its officers, employees and volunteers involved
in the provision of accreditation services from any claims, demands, losses or damages arising from the
program’s withdrawal from the accreditation process or any change in accreditation status provided that the
withdrawal or change is not the result of CMA’s negligence.
Administrator*
Name _______________________________
Title ______________________________
Signature ____________________________
email______________________________
Program request for accreditation
*
iii
Individual representing the corporate authority for the program, for example: CEO/President; Assistant CEO/Vice-President; Dean,
etc. This individual will receive all communications regarding accreditation policies and the program’s accreditation status.
Program request for accreditation
iv
Program* accountability
(To be completed by programs with joint corporate authority)
List of key accountabilities
Name of
institution
Name of
institution
Name of
institution
Makes strategic decisions about the program
Makes financial decisions about the program
Owns the intellectual property of the program
(curriculum, courses, etc.)
Executes agreements with clinical or practicum sites
Employs program personnel
Accepts students into the program
Provides liability insurance for students
Provides learning resources for the program
Approves program policies
Grants academic recognition, e.g.
certificate/diploma/degree
Conducts total program evaluation
*
Program = the integrated resources and educational components of all sites (didactic and clinical) participating in the delivery of
the educational process.