Exam Form

Training Application Form

Fill out the form carefully to apply for the ACP training program.
To apply for the ACP training course please complete the form and attach the following documentation:
- Letter outlining your interest in the area, current knowledge level of phlebology and what you hope to achieve by completing the training course.
- Current CV
- Current Registration number as a medical practitioner in Australia or New Zealand
- A medicare provider number is necessary to continue on to advanced training.
Note this form is for the clinical training program only. Another form is to be completed for the Graduate Certificate of Phlebology through ACD.
Upload CV*
Upload Application Letter*
Applicant Name*

First NameLast Name
Applicant E-mail*
example@example.com
Mobile Number*

Area CodePhone Number
Postal Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your Medical Registration Number?
What is your Medicare Provider Number?
Course*
State Applying for Position*
Have you already secured a College Fellow as your Supervisor, if so who?
Have you had any disciplinary actions in the past or pending from any medical regulatory body such as AHPRA or HDC. If so, please provide details below.
Will you be completing your training full-time or part-time?

Full-timePart-time
Pre-requisites

Applicants must:
> have resident status in Australia or New Zealand
> have current registration as a medical practitioner in Australia or New Zealand
> have a recognised medical post graduate qualification (eg FRACGP) or more than 3 years post graduate experience in clinical medicine
> have a medicare provider number to apply for advanced training.
Do you meet the pre-requisites to apply for the ACP training program? (if not you will not be eligible to apply)*

Yes
An application fee of $220.00 applies to all training applications. This application fee is NOT deducted from the training and examination fees and is not-refundable. Trainees will also have to register as trainee members of the college which incurs a fee of $945.00 for the first year, each additional membership year also incurs a fee depending on which level of training you have reached.

Please Note:
- Once applications close you will be requested for a video interview.
- Positions are subject to availability in each state.
- Submitting an application does not guarantee a training position.
- If you are unsuccessful you will be required to apply again for the following year.
- Once all applications have been considered you will be notified of the outcome of your application.
Declaration

I hereby authorise The Australasian College of Phlebology to direct debit my credit card for the non-refundable application fee.
Signature*

Clear

Training Application Fee*

Training Application Fee

$220.00AUD Quantity

Subtotal

$0.00AUD

Tax

$0.00AUD

Total

$0.00AUD

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Should be Empty:

Training Application Form

Pre-requisites

Declaration