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Forms

All the forms required by trainees in their dealings with the College can be found below. Requests to the Director of Professional Affairs Assessor (DPA Assessor) require specific forms that can be found on the special requests web page.

 

For forms with multiple pages, please ensure that all sheets are stapled and/or clearly identified.

 

If you cannot find the form you are looking for, please contact the Records Management unit at records@anzca.edu.au.

Applications for the ANZCA training program and fellowship

Application and Registration Form
 Registering as a trainee with the College is a two step process. You may apply and/or register using this form.
ANZCA Training Program Application Agreement
 This agreement sets out the rights, responsibilities and obligations of both the applicant and the College. When applying, this must be submitted with the Application and Registration form.
Training Agreement
 This agreement outlines the roles and responsibilities of the trainee and the College throughout the ANZCA training program. When registering, this agreement must be submitted with the Application and Registration form.
Application for Fellowship by Training and Examination Form
(all candidates)
                                            
 This application is completed when all training program requirements have been met and is submitted to Council for approval. It includes the Communication Consent Form and Medicare Notification. Once Fellowship has been obtained the College will notify the Australian Health Practitioner Regulation Agency (AHPRA) of admittance to fellowship.
Application for reconsideration of a training decision
 This application should be used by any trainee who wishes to initiate a formal reconsideration process under Regulation 30 for a training decision that they are dissatisfied with, and adversely affected by. This application form must be submitted along with a letter to the CEO within six months of the decision.

 

Payment forms


Online form

2013 Annual fee form

                    
 This form is used for paying the 2013 annual training fee for those trainees in approved training, or a registration maintenance fee for those not in training. Due dates: Australia and New Zealand - January 31; Hong Kong, Singapore and Malaysia - June 30.

2012 Training Fee Form


2011 Training Fee Form

 

2010 Training Fee Form 

 Earlier annual training fees Training fees for earlier years are set at the 2010 annual training fee level. If you have undertaken pre-2010 training and not paid a fee for that year, please use the 2010 Training Fee Form, write the year for which you are making a payment, and select the appropriate fee.          
Payment Form
 Generic payment form. Do not use this to pay the registration fee, annual training fee or registration maintenance fee.

 

Examinations

2013 Primary examination application forms:

(2004 curriculum - old exam)

 

(2013 curriculum - new exam)

 This form must be received by the College prior to the closing date for applications. Check your trainee profile and outstanding documentation report to ensure that you have met all eligibility requirements.
2013 Final Examination application forms
2004 curriculum

2013 curriculum
 This form must be received by the College prior to the closing date for applications. Check your trainee profile and outstanding documentation report to ensure that you have met all eligibility requirements.
2013 IMGS performance assessment application form For use by international medical graduate specialist (IMGS) applicants who have been interviewed by an IMGS panel and have met all eligibility criteria.

 

Assessments

in-training assessment form (for supervisors only)
Online form


ITA form (hard copy)
                                            		 The ITA form is valid for terms in the 2010 hospital employment year onwards
The online in-training assessment (ITA) form should be used by all supervisors of training (SOTs). Only supervisors who do not have access to the online form should use the hard-copy form. These include:
  • Intensive Care supervisors who are Fellows of the College of Intensive Care Medicine who do not have ANZCA website access (all FANZCA supervisors have access).
  • Supervisors in non ANZCA-accredited hospitals where training has been pre-approved by the DPA Assessor.  (Generally hospitals in non-ANZCA regions.)
ITA Short Form (for use by consultants)
ITA-SF (hard copy)

ITA-SF (interactive pdf)
 The ITA Short Form should be used by senior consultants to provide feedback on trainees. It is available in two formats, hard copy and electronic (interactive). The minimum requirement for the interactive form is Adobe Reader 8. For the latest version of Adobe Reader, click here. For further details on the ITA process see the ITA frequently asked questions page.


 

Modules and EMAC/EMST

Module Completion Form
 This form should be completed and returned to the College at the completion of each module.
Formal Project Registration Form (FPA)
                                      		 This form should be used to register a formal project and to seek approval and advice from the formal project officer via the regional/national office.
Formal Project Completion Form and Supervisors Report (FPB)
This form must be submitted at the end of the formal project to the regional/national office with which the project was registered.
EMAC and EMST courses Website link for information on the Effective Management of Anaesthetic Crises (EMAC) and the Emergency Management of Severe Trauma courses (EMST).Send the completion certificate to records@anzca.edu.au.
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