Application Form – 2024.1 PHRM Written Examination

PHRM Written Examination Registration Form

Please apply in the form below.
Trainee Name*

First NameLast Name
ACEM ID*
Email*
example@example.com
Preferred Contact Number*
AHPRA/MCNZ Registration Number*
Are you re-sitting the examination?*

YesNo
On the date of the Written Examination will you be in a PHRM placement?*

YesNo
Name of nominated invigilator*
Invigilator email address*
example@example.com
Invigilator phone number*
Name of PHRM site*
Please nominate the DipPHRM training site, or your current place of work, at which you will be undertaking yourDipPHRM examination. (NB Candidates cannot sit the examination from a personal residence. Candidates must have a suitable nominated invigilator to supervise them sitting the exam.)*

Eligibility Requirements

All the below requirements must be satisfied to be eligible to sit this examination.
Are you an enrolled ACEM PHRM trainee?*

YesNo
Do you hold current registration to practice medicine in Australia or Aotearoa New Zealand?*

YesNo
Did you commence a FULL DipPHRM Placement prior to 1 February 2022?*

YesNo

Acknowledgement

Please acknowledge each statement below.
View the DipPHRM Examinations Terms of Candidature.
It is solely my responsibility to ensure I meet all eligibility criteria by the closing date.*
If any of the eligibility criteria is altered, or has conditions not approved by ACEM at the time of the examination, I will not be eligible to sit the examination and all monies paid will be forfeited.*
I have read and understood the PHRM Examinations Terms of Candidature and agree to abide by them.*
Once deemed eligible to sit, I agree to make payment in full within the allocated timeframe.*
Candidates will receive a receipt of application via email once submission is complete. If you do not receive a response to your application within 48 hours you should make enquiries to the PHRM Training Team.
Should be Empty:

PHRM Written Examination Registration Form