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Approved Provider Required Program Reviewer
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Required Program Reviewer Update Form

In accordance with the Approved Provider Criteria and Standards, Approved Providers must notify APT when a change occurs in their Required Program Reviewer.

Please use the form below to submit the name, credentials and contact information for the Registered Play Therapist (RPT) or Registered Play Therapist-Supervisor (RPT-S) who will be the new designated Program Reviewer for your Approved Provider Status. Note that you will be asked to upload a completed Required Program Reviewer Attestation Form and should have this completed prior to attempting to submit this form.

For questions concerning the Approved Provider Program, contact Alexandra Jarrell, Continuing Education & Credentialing Coordinator,, or 559-298-3400 x4.

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New Program Reviewer must complete this attestation.