Application for Certificate in Molecular Pathology - Extension to scope of Practice

ESSENTIAL INFORMATION - PLEASE READ

This Training and Assessment Pathway is offered to those who require upskilling in molecular/genomic methods within their discipline.

Requirements for this pathway will be fulfilled through attainment of competency, rather than by a defined training time, with appropriate supervision and both formative and summative assessments.

You must notify the College of your intent to pursue an extension to scope of practice.

Please note: FRCPA Trainees who are yet to complete and pass all examination and assessment requirements are not permitted to enrol to sit Molecular Pathology Certificate examinations but may commence collecting evidence for their portfolio. Only RCPA Fellows are permitted to enrol to sit the examinations.

PERSONAL DETAILS

RCPA ID *

First Name *

Middle Name

Last Name *

Preferred NameIf applicable

Home Address *

Street address *

City *

State *

Postcode *

Country *

Mobile Phone *

Email Address *

WORKPLACE

Workplace Name *

Workplace Address *

Street address *

City *

State

Postcode

Country *

TRAINING STATUS

Please select one *

I am a FellowI am a Trainee

As a Trainee, you are permitted to complete the portfolio requirements whilst still pursuing FRCPA Fellowship training (provided you have the correct supervisor), however you are only permitted to sit the examination once you have attained FRCPA Fellowship.

TRAINING DETAILS

Module *

Somatic NGS ModuleGermline NGS Module

Module *

Module 2Module 3

Module *

Module 3Module 4

Module *

Module 1Module 2Module 3

Module *

Module 1Module 2

Molecular Pathology Training Commencement Date *

Supervisor Name *

Supervisor Email *

My Supervisor is *

RCPA Genetic Pathology FellowRCPA Fellow in relevant discipline who has certification in the Module being pursued

Supervisor 2 Name (optional)

Supervisor 2 Email (optional)

My Supervisor is (optional)

RCPA Genetic Pathology FellowRCPA Fellow in relevant discipline who has certification in the Module being pursued

In which Laboratory will you complete training? *

Laboratory Address *

Street address *

City *

State *

Postcode

Country *

Do you and your Supervisor both work at this Laboratory? *

YesNo

It is a requirement where the Candidate and Supervisor work in different labs / jurisdictions, then a prospective and detailed training plan needs to be submitted clearly articulating how the Handbook portfolio requirements will be met and signed off.

Please upload a prospective and detailed training plan *

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PRIVACY AND CONFIDENTIALITY

The College is collecting your personal information (including your name, contact details and qualifications) in connection with providing you with training and further education. Any information you provide will be treated as strictly confidential by the College. However, in the course of your training it may be necessary for the College to provide your name, contact details and information about your progress or examination performance to College committees and Fellows of the College who are involved with supervision and training. The College may also disclose your personal information to your employer, any medical or regulatory body including disclosure overseas, if this is specifically required to be disclosed. If the personal information is not provided to the College, the College may be unable to process your application, or to review and assess your training progress and examination performance. The College will manage your personal information in accordance with its Privacy Policy, which sets out how you can access and correct personal information that we hold about you, as well as our complaints handling process. To obtain a copy of our Privacy Policy please contact our Privacy Officer on + 61 2 8356 5858 or visit our website: https://www.rcpa.edu.au/Library/College-Policies/Policies/Privacy-Policy.

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