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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.
* = Required

Personal Information

Previous QSR Reviewer Experience

  • * Have you ever been a QSR reviewer before? Yes No
  • How many times have you been a QSR reviewer? 
  • In what county have you been a QSR Reviewer? Please check all that apply.
  • Adams
  • Allegheny
  • Beaver
  • Butler
  • Clarion
  • Crawford
  • Cumberland
  • Dauphin
  • Delaware
  • Erie
  • Fulton
  • Lackawanna
  • Lebanon
  • Lycoming
  • Luzerne
  • Montgomery
  • Mifflin
  • Philadelphia
  • Schuylkill
  • Snyder
  • Union
  • Venango
  • Warren
  • Washington
  • .
  • Wyoming
  • York

  • When was the last time you were a QSR reviewer?  Month:   Year:
  • I don't remember the last time I was a QSR Reviewer

  • How did you learn about the opportunity to be a QSR Reviewer?




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.

  • I can bring a work/personal laptop with me to be used by myself and my QSR review partner
  • I am willing to drive myself and my partner to scheduled interviews
  • I am willing to travel greater than 1 hour from onsite QSR location to interview(s)
  • I am willing to conduct interviews in the evening, if needed
  • I feel comfortable interviewing children/youth
  • I have professional experience and/or a very good understanding of the Public Child Welfare System

Please summarize the reasons you are interested in being a reviewer for a Quality Service Review.



Please share any information you would like to share that might assist QSR Site Leads
in their selection and pairing.



Current Availability - Dates and Locations

How many times are you able to review from now through December 2017? 

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.

  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December


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 identify what months you will tentatively be available to be a QSR Reviewer.

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 - all counties
  • Allegheny
  • Armstrong
  • Beaver
  • Butler
  • Cameron
  • Clarion
  • Clearfield
  • Crawford
  • Erie
  • Elk
  • Fayette
  • Forest
  • Greene
  • Indiana
  • Jefferson
  • Lawrence
  • McKean
  • Mercer
  • Potter
  • Venango
  • Warren
  • Washington
  • Westmoreland


  • Central Region - all counties
  • Adams
  • Bedford
  • Blair
  • Cambria
  • Centre
  • Clinton
  • Columbia
  • Cumberland
  • Dauphin
  • Franklin
  • Fulton
  • Huntingdon
  • Juniata
  • Lancaster
  • Lebanon
  • Lycoming
  • Mifflin
  • Montour
  • Northumberland
  • Perry
  • Snyder
  • Somerset
  • Union
  • York


  • Northeast Region - all counties
  • Bradford
  • Carbon
  • Lackawanna
  • Lehigh
  • Luzerne
  • Monroe
  • Northampton
  • Pike
  • Schuylkill
  • Sullivan
  • Susquehanna
  • Tioga
  • Wayne
  • Wyoming


  • Southeast Region - all counties
  • Berks
  • Bucks
  • Chester
  • Delaware
  • Montgomery
  • Philadelphia


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.