Consultant Application Section 1. Consultant Criteria SCCM Member (required for all applicants) To become an FCCS: OB consultant, an applicant must fulfill ONE of these two eligibility pathways. Please select one 1. Current FCCS consultants Current FCCS consultants may also serve as consultants for FCCS: OB courses. Type Information (English Only) (* denotes required field). 2. Current FCCS: OB directors Teach/Direct in at least two approved FCCS: OB courses in the previous two years Submit the FCCS: OB Course Consultant Letter of Recommendation Section 1. Contact Information *Last Name: *First Name: Middle Initial: *Credential(s): *SCCM Member No.: *Contact Info: Institution: *Street Address: *City: State/Province: Zip Code: *Country: *Telephone: Fax: *Email: Section 2. Course Information *FCCS: OB courses you directed: *Date: *Course Site: *Date: *Course Site: Section 3. Consultant Information *Would you act as a consultant for out-of-state or international courses? Yes No *Letter of recommendation provided by: *Applicant Signature (Name of active FCCS or FCCS: OB Consultant) I certify that the above information is true and accurate. Typing name in the signature space provided shall serve as lawful signature as if signed by hand in person. ALLOW 2-4 WEEKS FOR PROCESSINGAPPLICATION