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CAC Application Form

Certified Application Counselor (CAC) Organizations must be approved by the Exchange prior to individual CACs obtaining Exchange appointment.

Steps:

  1. In order to participate in Nevada’s Certified Application Counselor (CAC) Program, all organizations that want to be certified as CAC Organizations must initially fill out the form below.
  2. The organization must include a listing of staff members who plan to be certified as an Exchange Enrollment Facilitator (EEF/CAC) to help Nevadans enroll through Nevada Health Link. Staff names must be entered one at a time, first name then last name, ensuring there is no more than one staff member on one line. Note: Forms submitted incorrectly will not be reviewed.
  3. Organizations will be approved by Nevada Health Link and a list of the organizations (and approved staff) will receive notice from Nevada health Link regarding training information assisting consumers..
  4. If you are interested in receiving assistance to pay for the certification, please review the process and requirements outlined here.

Basic Information



How Can the Marketplace Contact Your Organization?









How Can the General Public Contact Your Organization?









Hours of Operation















Organization Details

Do one or all of the following apply to your organization? Answer yes or no for all that apply.


Yes No

Yes No

Yes No

Yes No

Privacy and Security Experience

Does your organization already:


Yes No

Yes No

Yes No

Yes No

Reporting to the Exchange per CFR 45 155.225


Agree Disagree

Agree Disagree

Approved Team Members


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