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 PROCESSING APPLICATION