CPD APPROVAL APPLICATION FORM

National Register of Reflexologists (Ireland)

Application

for

CPD COURSE APPROVAL

(for short post-graduate courses)
General Notes for Applicants:

1. Please aim to submit as much information as possible to support your application.

2. If you wish to include any additional information which is not included in this form please use field 'ADDITIONAL INFORMATION' just before signature page.

3. Fields marked as * are mandatory. Application cannot be submitted without them.

4. Please enter N/A in required fields which are not relevant in your application.

5. Please allow 2-3 weeks for the 'NRRI Education Committee' to process your application. You will be notified by email when decision is made.

6. If you wish to SAVE your progress and FINISH LATER go to Section E and find button 'SAVE'.
MAIN SECTION - Course's General Information
TITLE OF COURSE*
Modality/Therapy*
If this Course has been previously approved/accedited by other Professional body(ies) please give: 1. Date 2. Name of association 3. CPD credits allocated

Part A - Applicant's Details
Part A - Applicant's Details
1. Full Name*

First NameLast Name
2. Email*
example@example.com
3. Phone Number*
Please enter a valid phone number.
4. Address*

Street Address

Street Address Line 2

CityCounty

Eircode

Part B - Tutor's Qualifications
Part B - Tutor's Qualifications
1.Details of Therapy Qualifications*
(e.g. diploma + year of graduation)
2. Details of Teaching Qualifications*
(e.g. Train the Trainer / Training, Delivery & Evaluation / + year of graduation)
3. Evidence of post-graduate courses (CPD) completed since qualifying.If you have been a NRRI Member for the last three year please enter: NRRI*
(Please list all relevant CPD accomplishments since graduation: Title + date)
4. Details of Teaching Insurance*
(Name, number and expiry date of the insurance policy)
5. Professional Indemnity Insurance*
(Name, number and expiry date of the insurance policy)
6. Employer's Liability Insurance (if you employ staff)*
(Name, number and expiry date of the insurance policy, enter N/A if you don't employ staff)
7. First Aid Certificate*
(Name of provider, number and expiry date)
8.1 Evidence of Tutor's MINIMUM 3 YEARS of practical/clinical experience(NRRI MEMBER)*
Your NRRI MEMBERSHIP NUMBER (if not member enter: N/A)
8.2 Evidence of Tutor's MINIMUM 3 YEARS of practical/clinical experience(NON-MEMBER).Please submit one of the below:*

8.2.1 Contact details of a client(s) to confirm the above (enter details)8.2.2 Other Association CPD Record (please upload)8.2.3 Dated insurance certificates (please upload)Please use my NRRI Membership Record (CPD Programme/Insurance)
Details of a Client(s) for choice 8.2.1. Please note that you are obliged to obtain client's consent that we may contact him/her to validate your 3 years clinical experience.*
(Full Name + Mobile phone or Email)(if you chosen other option to validate your experience please enter N/A)
Please upload chosen Evidence of Practical Experience for choices 8.2.2 or 8.2.3 :

(Files preferably as .PDF or .JPG / Please upload files named as 5.2.1, 5.2.2, respectively)
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Part C - Course Overview & Content
Part C - Course Overview
Student Entry Level*
Total Number of Contact Hours*
Total Number of Self-Study Hours*
Course Assessment / Grading*
(E.g. exam, case studies, practical assessment.)
Certification*
(E.g.. practitioner, attendance, completion)
Part C - Course Content
Note: for Sections C1-C5 below please either give short, but thorough description/list or enter 'attached' and upload file(s).
C1. Course SYLLABUS*
(please type: 'ATTACHED' and upload as attached file Name: C1)
C2. Schemes of work / Teaching aids*
(e.g. power point, flipchart, etc) or (please type: 'ATTACHED' and upload as file Name: C2)
C3. Lesson Plan*
(please type: 'ATTACHED' and upload as file Name: C3)
C4. List of Course Handouts / Presentations*
(alternatively please type in: 'ATTACHED' and upload as file Name: C4)
C5. Reading List*
(alternatively type in 'ATTACHED' and upload as file Name: C5)
Files Upload for Sections C1-C5 - Course Content

(Files preferably as .PDF or .JPG)! Please use files named as C1, C2... respectively)
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Part D - Policies and Risk Assessment
Part D - Policies and Risk Assessment
Please tick ALL THE BOXES as a confirmation that each listed Policy / Risk Assessment is set up for your course and place of teaching, and that copy will be provided if requested:*

Health & Safety PolicyComplaints PolicyEqual Opportunities PolicyPrivacy PolicyRisk Assessment for the CourseRisk Assessment for the VenueAccident BookFirst Aid Kit
ADDITIONAL INFORMATION:
(If you wish to add information that is not included in this application)

Part E - Non-Plagiarism Declaration & Signature
Part E - Non-Plagiarism Declaration & Signature

Please read, tick a box and sign/date this section
"I hereby declare, that the above is my own work, except where indicated by the reference to the printed and electronic sources used according to the internationally accepted rules and regulations on intellectual property rights.

I hereby declare that I am aware of what constitutes an act of plagiarism."
Please tick here:*

Yes, I declare.
By signing this form "I certify that above facts are true to the best of my knowledge and belief, and I understand that my application will be rejected in the event the above facts are found to be falsified".Applicant's Signature*

Powered by Jotform SignClear
Date of submission:*

DayMonthYear
Date
Important: To SAVE your PROGRESS, please -> click on SAVE button -> click on Skip Create and Account -> Enter your EMAIL and -> click SEND! You will receive an email with link to CONTINUE your submission!
NRRI Verifier
NRRI Verifiers

Name

Name

CPD AllocatedState / Province

Date
Should be Empty:

MAIN SECTION - Course's General Information

Part A - Applicant's Details

Part B - Tutor's Qualifications

Part C - Course Overview

Part C - Course Content

Part D - Policies and Risk Assessment

Part E - Non-Plagiarism Declaration & Signature