QSR Reviewer Application
Thank you for your interest in being a Quality Service Review (QSR) Reviewer! Please provide the following information to assist us in our QSR reviewer recruitment, selection and pairing efforts.
Personal Information

Previous QSR Reviewer Experience

Additional Information About You
The following statements include information that will aid us in pairing you with your review partner.
Please check all that apply:

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Current Availability - Dates and Locations

Not all the dates for the upcoming QSRs have been identified at this time. Please identify what months you will tentatively be available to be a QSR Reviewer.
Please select all months that you might be available. NOTE: We understand that your schedule might change.

Not all locations for the upcoming QSRs have been determined at this time.  Please identify what counties you would be interested in going to for a QSR.
Please select all counties to which you would be willing to travel. NOTE: We understand that your ability to travel to certain locations might change.
Western Region

Central Region

Northeast Region

Southeast Region

Please review all the information you have entered and when ready, click the SUBMIT button below. Your information will be provided to those that manage our statewide database of potential QSR reviewers and your information will be available to CQI State Site Leads who are responsible for QSR reviewer recruitment and selection.