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*AAMC-301*
Application for assessment by a medical college
Profession: Medical
AAMC-30
Health Practitioner Regulation National Law (the National Law)
Effective from: 15 August 2017 Page 1 of 9
This form is for international medical graduates (IMG) who are seeking limited
registration for postgraduate training or supervised practice in order to
undertake short term specialist training (usually up to 24 months), and require
assessment by a medical college as part of that application process.
The purpose of this application is to enable the college to advise the Medical
Board of Australia (the Board) on the suitability of the specifed training
position for the IMG. The Board requires this advice from the college to help
decide on the eligibility of the IMG for registration in the short term training
in a medical specialty pathway. This pathway does not lead to specialist
registration. Applicants seeking to qualify for specialist registration must
be in the specialist pathway – specialist recognition.
For more information, refer to the Board’s registration standard for specialist
registration at www.medicalboard.gov.au/registration-standards
This application comprises:
• Part A: to be completed by the applicant and the employer/sponsor, and
• Part B: to be completed by an authorised college representative
It is important that you refer to the Board’s registration standard for limited
registration postgraduate training or supervised practice and the guideline
Short term training in a medical specialty for international medical graduates
who are not qualifed for general or specialist registration before completing
this application. Registration standards, codes and guidelines can be found
at www.medicalboard.gov.au
This application will not be considered unless it is complete
and all supporting documentation has been provided. Supporting
documentation must be certifed in accordance with the Australian
Health Practitioner Regulation Agency (AHPRA) guidelines.
See Certifying documents in the Information and defnitions section
of this form.
Privacy and confdentiality
The Board and AHPRA are committed to protecting your personal information in
accordance with the Privacy Act 1988 (Cth). The ways the Board and AHPRA may collect,
use and disclose your information are set out in the collection statement relevant to this
application, available at www.ahpra.gov.au/privacy.
By signing this form, you confrm that you have read the collection statement. AHPRA’s
privacy policy explains how you may access and seek correction of your personal
information held by AHPRA and the Board, how to complain to AHPRA about a breach of
your privacy and how your complaint will be dealt with. This policy can be accessed at
www.ahpra.gov.au/privacy.
Symbols in this form
Additional information
Provides specifc information about a question or section of the form.
Attention
Highlights important information about the form.
Attach document(s) to this form
Processing cannot occur until all required documents are received.
Signature required
Requests appropriate parties to sign the form where indicated.
Completing this form
• Read and complete all questions.
• Ensure that all pages and required attachments are returned to AHPRA.
• Use a black or blue pen only.
• Print clearly in B L OC K L E T T E RS
• Place X in all applicable boxes:
• DO NOT send original documents unless specifed.
Do not use staples or glue, or affx sticky notes to your application.
Please ensure all supporting documents are on A4 size paper.
PART A – To be completed by the applicant and the employer/sponsor
SECTION A: Applicant details
1.
What are your name and
birth details?
If you have ever been
formally known by another
name, or you are providing
documents in another name,
you must attach proof of your
name change.
For more information, see
Change of name in the
Information and defnitions
section of this form.
Title MR MRS MISS MS DR OTHER SPECIFY
Family name
First given name
Middle name(s)
Previous names known by (e.g. maiden name)
Date of birth D D / M M / Y Y Y Y
Country of birth
AAMC-30 *AAMC-302*
Effective from: 15 August 2017 Page 2 of 9
2.
What are your contact and
address details?
Please provide the contact
and address details where
you can be contacted about
this application.
Provide your current contact details below – place an next to your preferred contact phone number.
Business hours
After hours
Mobile
Email
Site/building and/or position/department (if applicable)
Address (e.g. 123 JAMES AVENUE; or UNIT 1A, 30 JAMES STREET)
City/Suburb/Town*
State or territory (e.g. VIC, ACT)/International province* Postcode/ZIP*
Country (if other than Australia)
SECTION B: Primary source verifcation of qualifcations
When you apply for registration, you will need to have applied to have your qualifcations verifed through the Educational Commission
for Foreign Medical Graduates (ECFMG) Electronic Portfolio of International Credentials (EPIC). The Australian Medical Council (AMC) will
provide the verifcation to the Board. For more information about the process go to the AMC website www.amc.org.au
The college and AHPRA will use your AMC candidate number to link your Application for assessment by a medical college – AAMC-30
to your application for registration.
3.
Have you applied to have
your qualifcations verifed?
YES Provide your details below NO I have not yet applied for verifcation
AMC candidate number
4.
What is your primary
medical degree?
Primary medical degree
Title of qualifcation
Name of institution (University/College/Examining body)
Country
Start date Completion date
M M / Y Y Y Y M M / Y Y Y Y
You must attach an original certifed copy of your primary medical degree certifcate that
indicates completion of a course of study leading to a qualifcation in medicine.
Attach a separate sheet if all of your academic qualifcations and examinations/assessments
do not ft in the space provided.
AAMC-30 *AAMC-303*
Effective from: 15 August 2017 Page 3 of 9
5.
What is the name of the
overseas specialist college/
body awarding the specialist
qualifcation, or with whom
are you a specialist-in
training?
Name of specialist college/body
State/Province
Country
6.
What is the specialist
qualifcation awarded (or to
be awarded) by the above
college/body upon completion
of training?
Specialist qualifcation awarded
7.
What is the specialist training
area (e.g. anaesthetics,
neonatology, etc.) of the
proposed training position?
Specialist training area
8.
Who is the contact person
(employer or sponsor)
nominated to act on behalf
of the applicant?
Title
MR MRS MISS MS DR OTHER SPECIFY
Family name
First given name
Business hours contact phone number
After hours
Mobile
Email
AAMC-30 *AAMC-304*
Effective from: 15 August 2017 Page 4 of 9
9.
What are the employer’s/
institution’s/supervisor’s
contact details?
Provide your employer’s/institutions’s/supervisor’s contact details below
Please specify: Employer Institution Supervisor
Employer’s/institutions’s/supervisor’s name
Site/building (if applicable)
Address (e.g. 123 JAMES AVENUE; or UNIT 1A, 30 JAMES STREET; or PO BOX 1234)
Suburb/City/Town
State or territory (e.g. VIC, ACT)/International province
Business hours contact phone number
After hours
Postcode/ZIP
Mobile
Email
10.
In which Australian state
or territory will the training
position be located?
State or territory of training
VIC NSW QLD SA WA NT TAS ACT
AAMC-30 *AAMC-305*
Effective from: 15 August 2017 Page 5 of 9
SECTION C: Supporting documentation
Please check with the relevant college website as further specifc information may be required by some colleges.
Note: Further registration requirements apply, including a signed declaration from the applicant that at the time of registration they
have no intention of making further applications for registration at the end of the specifed training period (usually up to 24 months).
Please check with the relevant college website for the fee payable to the college to undertake an assessment. This fee may vary from
college to college and fee payment must be included with this application form.
Any application form submitted to a college without fee payment will be returned directly to the employer/sponsor to seek payment
before an assessment can take place.
It is important that you refer to Curriculum vitae in the Information and defnitions section of this form for mandatory requirements
of the CV.
The following documents must be attached to this application and submitted to the relevant college:
• a position description for the proposed training position
• a training plan providing details of the purpose, anticipated duration, location, content and structure of training in Australia
and the anticipated date of any examinations or assessments
• details of how supervision will be provided and the names and contact details of proposed supervisor(s), and
(Note: Proposed supervision arrangements must meet the requirements of the Board’s Guidelines – Supervised practice for
international medical graduates)
• signed and dated curriculum vitae of the applicant.
If you are a specialist-in-training or an internationally qualifed specialist, you must also attach or organise additional documents.
For specialists-in-training
A statement from the overseas specialist college or body awarding the specialist qualifcation with whom the applicant is a trainee
in the country of training. The statement must:
• confrm your trainee status with the college/body
• outline the content, structure and length of the overseas training program
• confrm that you are not likely to be more than two years from completing your specialist training
• confrm that you have passed a basic specialist examination or satisfactorily completed substantial training (generally three
or more years i.e. PGY 5), and
• identify the objectives of the short term training to be undertaken in Australia.
For internationally qualifed specialists
A statement from the overseas specialist college or body awarding the specialist qualifcation that confrms the applicant’s specialist
qualifcation in the country of training
SECTION D: Consent
Before you sign and date this form, make sure that you have answered all of the relevant questions correctly and read the statements
below. An incomplete form may delay processing and you may be asked to complete a new form.
Applicant’s declaration – To be completed and signed by the applicant
I confrm that:
• I have read the privacy and confdentiality statement for this form, and
• at this time, I have no intention of making further application for registration at the end of the specifed training period.
I agree to:
• release of the college assessment direct to AHPRA, and
• the employer/sponsor nominated on this form to act on my behalf in matters relating to this application.
Name of applicant
Date
D D / M M / Y Y Y Y
Signature of applicant
SIGN HERE
AAMC-30 *AAMC-306*
Effective from: 15 August 2017 Page 6 of 9
Employer/sponsor signature – To be completed and signed by the employer/sponsor
I agree to act on behalf of the applicant in matters relating to this application.
Name of employer/sponsor
Name of institution
Date
D D / M M / Y Y Y Y
Position of employer/sponsor
Signature of employer/sponsor
SIGN HERE
SECTION E: Checklist
Have the following items been attached or arranged, if required?

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Additional documentation AttachedQuestion 4 An original certifed copy of your primary medical degree certifcate that indicates completion of a course of studySection C Position description for the proposed training positionSection C Training plan providing details of the training in Australia and the anticipated date of any examinations or assessmentsSection C Details of the how supervision will be provided and the names and contact details of proposed supervisor(s)Section C Curriculum vitae of the applicantSection C For specialists-in-training
A statement from the overseas specialist college or body awarding the specialist qualifcation with whom the applicant is a
trainee in the country of training. The statement must:
• confrm your trainee status with the college/body
• outline the content, structure and length of the overseas training program
• confrm that you are not likely to be more than two years from completing your specialist training
• confrm that you have passed a basic specialist examination or satisfactorily completed substantial training (generally three
or more years i.e. PGY 5), and
• identify the objectives of the short term training to be undertaken in Australia.Section C For internationally qualifed specialists
A statement from the overseas specialist college or body awarding the specialist qualifcation that confrms the applicant’s
specialist qualifcation in the country of training
AAMC-30 *AAMC-307*
Effective from: 15 August 2017 Page 7 of 9
PART B – To be completed by an authorised college representative
The applicant must provide the employer/sponsor with a copy of Part B of this form.
SECTION F: Applicant suitability
The Board requires the college to provide the information below. This information will help the Board decide on the applicant’s eligibility
for registration in the short term training in a medical specialty pathway.
11.
Does the applicant meet
the Board’s exemption
from the eligibility criteria
for this pathway?
From time to time international specialists or specialists in training registered in New Zealand may be required
by an accredited college to undertake rotations in Australia. Some of these trainees may be more than 2 years
away from completing their specialist training. To enable them to complete college requirements, the Board may
grant an exemption to the requirement to be no more than two years away from completing specialist training,
where the applicant for registration:
• is not qualifed for general registration in Australia, and
• holds registration in a general scope with the Medical Council of New Zealand, and
• is an accredited trainee with an Australian Medical Council accredited specialist medical college.
N/A The applicant is not a New Zealand college trainee
Go to the next question
YES The applicant meets the Board’s requirements
Go to the next question
12.
What is the duration of the
training period in Australia?
Duration of training period
SPECIFY
13.
Is the training position/
program suitable for
the applicant?
The college assessment of whether the training position is suitable for the applicant will take into consideration:
a) whether the applicant appears to be a genuine specialist in training or internationally qualifed specialist
b) that the position the applicant is applying for is a genuine training position that is appropriate for the
applicant’s training requirements, taking into consideration their reported level of training and experience, and
c) that there is adequate supervision and support for the applicant’s level of training and experience.
This assessment will take into consideration the purpose and principles of supervision as set out in the Board’s
Guidelines – Supervised practice for international medical graduates.
For more information, see Genuine training position in the Information and defnitions section of this form.
YES Go to Section G: Specialist college details NO Provide reasons below
Suitability of training position/program
AAMC-30 *AAMC-308*
Effective from: 15 August 2017 Page 8 of 9
SECTION G: Specialist college details
14.
What are the details of the
specialist college?
Specialist college details
Name of college
Name of contact person
Business hours (phone) Mobile
Email
Address (e.g. 123 JAMES AVENUE; or UNIT 1A, 30 JAMES STREET; or PO BOX 1234)
Suburb/City/Town
State/Territory (e.g. VIC, ACT) Postcode
SECTION H: Authorised college representative
The college must attach copies of the documents provided by the applicant for assessment and forward this completed form to the
relevant AHPRA offce. The college may send the documents via mail or email to the relevant AHPRA offce.
Name of authorised college representative
Date
D D / M M / Y Y Y Y
Position of authorised college representative
Signature of authorised college representative
SIGN HERE
On completion of the
assessment by the college this
form and attachments should
be sent to:
AHPRA
GPO Box 9958
IN YOUR CAPITAL CITY (refer below)
The relevant capital city will be the city in which
the training position is located.
You may contact AHPRA on
1300 419 495 or you can lodge an enquiry
at www.ahpra.gov.au
Sydney NSW 2001 Canberra ACT 2601 Melbourne VIC 3001 Brisbane QLD 4001
Adelaide SA 5001 Perth WA 6001 Hobart TAS 7001 Darwin NT 0801
AAMC-30 *AAMC-309*
Effective from: 15 August 2017 Page 9 of 9
Information and defnitions
CERTIFYING DOCUMENTS
DO NOT send original documents unless specifed.
Copies of documents provided in support of an application, or other purpose
required by the National Law, must be certifed as true copies of the original
documents. Each and every certifed document must:
• be in English. If original documents are not in English, you must provide a
certifed copy of the original document and translation in accordance with
AHPRA guidelines, which are available at
www.ahpra.gov.au/registration/registration-process
• be initialled on every page by the authorised offcer. For a list of people
authorised to certify documents, visit www.ahpra.gov.au/certify
• be annotated on the last page as appropriate e.g. ‘I have sighted the
original document and certify this to be a true copy of the original’ and
signed by the authorised offcer, and
• list the name, date of certifcation, and contact phone number, and
position number (if relevant) and have the stamp or seal of the authorised
offcer (if relevant) applied.
Certifed copies will only be accepted in hard copy by mail or in person (not
by fax, email, etc). Photocopies of previously certifed documents will not be
accepted. For more information, AHPRA’s guidelines for certifying documents
can be found online at www.ahpra.gov.au/certify
CHANGE OF NAME
You must provide evidence of a change of name if you have ever been formally
known by another name(s) or any of the documentation you are providing in
support of your application is in another name(s).
Evidence must be a certifed copy of one of the following documents:
• Standard marriage certifcate (ceremonial certifcates will not be accepted).
• Deed poll.
• Change of name certifcate.
Faxed, scanned or emailed copies of certifed documents will not be accepted.
CURRICULUM VITAE
Your curriculum vitae must:
• explain any period since obtaining your professional qualifcations where
you have not practised and reasons why (e.g. undertaking study, travel,
family commitment)
• be in chronological order
• be signed and dated with a statement, ‘This curriculum vitae is true and
correct as at (insert date)’, and
• be the original signed curriculum vitae (no faxes or scanned copies
will be accepted).
It must also contain all the elements defned in AHPRA’s standard format for
curriculum vitae which can be found at www.ahpra.gov.au/cv
GENUINE TRAINING POSITION
Genuine training position means that the Australian training position that
the applicant has applied for is a training position accredited by an AMC
accredited specialist medical college or is a formal structured training
position which consists of formal assessment processes and mechanisms for
measuring learning outcomes. The training position is not primarily a service
position.

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