Continuing Professional Development Audit Form 2014/15 Write clearly using CAPITAL LETTERS and tick boxes where applicable Family Name: First Name(s): Membership ID: Country: If you have been awarded a part exemption please specify the number of CPD hours you have to complete _____ Section 1 Option 1: Provide details for each CPD activity that you have participated in. The total hours should equal the minimum requirement of 24 hours (unless you have been awarded a part exemption); up to 8 hours of this can be Independent CPD. Details should include dates, title of activity, type of evidence provided and number of hours or credits associated with it, see overleaf for further information. Continue on a separate sheet of paper if necessary and REMEMBER to send copies of your supporting evidence with this form. Date of Activity From CPD Activity To Evidence Provided (Please note you are not required to provide for Independent CPD activities) Hours/Credits Internal Use Total hours: Date of Activity From Independent CPD Activity To Hours (2 hr’s maximum per activity) Internal Use Total hours: Option 2: I will share my profile on the ePortfolio where you will find documents uploaded as evidence of my CPD activity for the period of 1 July 2014 to 30 June 2015 (please tick) (Please contact the CPD department at cpd@rad.org.uk for further information on how to share your information via the ePortfolio) Section 2 I confirm that the information I have given in this form is true and accurate to the best of my knowledge. I understand that submission of a false form is a breach of the Code of Professional Practice for teachers registered with the Royal Academy of Dance. By signing you are also declaring completion or non-completion of your CPD requirement for the 2014/15 year (if you have not yet submitted a declaration). Signature: Date: Send to Send this form directly to your national office. See the accompanying list of national offices for contact details. If you do not have a national office in your country, send this application to the United Kingdom. Internal Use Only Staff Initials: Date Received: Date Processed: Outcome: Version 2, June 2015 Royal Academy of Dance® is a Charity Registered in England & Wales No. 312826 Continuing Professional Development Audit Form - Instructions and Guidance The 2014/15 Continuing Professional Development year runs from 1 July 2014 to 30 June 2015. As part of the 2014/15 audit of your CPD activity, you must complete this form or the version available to download at www.rad.org.uk/cpdaudit and return it with supporting evidence. We will not be able to complete the audit of your activity without this form: Completing Section 1 Select either: Option 1; return this form with accompanying evidence to CPD department. Option 2 return this form and share your evidence with the Academy via your profile on the ePortfolio. Please contact the CPD department at cpd@rad.org.uk for further information on how to share your evidence via the ePortfolio. For both options you must evidence that you have met the minimum requirement of 24 hours of CPD or your remaining requirement if you received a part-exemption. For each activity that you have participated in, please include a copy of one piece of evidence only. Please note, we do not need evidence of more than 24 hours of CPD. All evidence must show: 1. Your name 2. The date (or range of dates) of the activities 3. Title of the activities 4. Confirmation of your attendance/participation in the activities Any evidence you include with the Audit Form must clearly verify your attendance/participation in the activity. Examples of evidence include but are not restricted to: • copies of certificates • letters of attendance Independent CPD: A maximum of 8 hours may be completed by participating in Independent CPD; each Independent CPD activity must be no more than 2 hours. As it is difficult to evidence Independent CPD, we do not require you to provide evidence of this. If however, for any reason we require clarification on a specified Independent CPD activity we reserve the right to ask you to provide further information. Please do not send original documents, as we cannot return them to you unless you provide a self- addressed stamped envelope. Completing Section 2 You must sign and date the form to confirm the information you have given is true and accurate to the best of your knowledge. Submission of a false form is a breach of the Code of Professional Practice for teachers registered with the Royal Academy of Dance. What happens when we receive your form? We will send you an email confirming receipt of your audit data. We will review the information you have sent us. If we need any further clarification or information regarding your evidence we will contact you either via email or telephone. Once we have reviewed the information you have sent us we will contact you to confirm whether you have successfully completed your CPD requirement for the 2014/15 CPD year. If after further consultation with you, you have been unable to demonstrate that you have met the minimum CPD requirement we will send confirmation that you have not completed your CPD requirement for the 2014/15 CPD year and explain what will happen next. Questions If you have questions about the CPD audit please contact your national office. See the accompanying list of national offices for contact details. If you do not have a national office listed for your country, contact the United Kingdom. Version 2, June 2015 Royal Academy of Dance® is a Charity Registered in England & Wales No. 312826 National Offices AUSTRALIA & PAPUA NEW GUINEA Royal Academy of Dance 20 Farrell Avenue Darlinghurst NSW 2010 Australia t: (61) 2 9331 4111 f: (61) 2 9360 6677 info@rad.org.au www.rad.org.au BENELUX & FRANCE Jacqueline Spence Royal Academy of Dance asbl 21 Cité Joseph Bech L-6186 Gonderange Luxembourg t: (352) 787225 f: (352) 787217 RAD-Benelux@pt.lu RAD-France@pt.lu www.rad.lu CHINA Professor Ting Tina Chen 2nd Floor Tower 2 Dong Hai Commercial Building 588 Yan An Dong Lu Shanghai China Tel: (86) 21 6597 6399 Fax: (86) 21 6513 7188 email: radchina@hotmail.com Chief Representative: Tel: 86 21 6598 9068 leendtina@gmail.com CYPRUS Mr George Shantos 19 Vassa Kilaniou 4771 Limassol Cyprus t: (357) 99 477 887 f: (357) 24 818 351 info@rad.com.cy www.rad.com.cy BRAZIL, PERU, ECUADOR & CHILE Maria do Carmo de Kenny Royal Academy of Dance Brasil Ltda. R Dr Francisco A Tozzi, 180 Estância Suiça 13930 000 Serra Negra-SP Brasil t/f: (55) 19 3892 3985 mckenny@royalacademyofdance.com.br www.royalacademyofdance.com.br GERMANY, AUSTRIA and SWITZERLAND Horst Vollmer Royal Academy of Dance gGmbH Waldenserstr 2-4 10551 Berlin Germany t: +49 (0)30 39 40 466 60 f: +49 (0)30 39 40 466 69 info@royalacademyofdance.de www.royalacademyofdance.de CANADA Royal Academy of Dance Suite 601, 1210 Sheppard Avenue E Toronto, Ontario M2K 1E3 Canada t: (1) 416 489 2813 f: (1) 416 489 3222 info@radcanada.org www.radcanada.org GREECE Veta Anastasopoulou The British Council 17 Kolonaki Square Athens 10673 Greece t: (30) 210 364 3691 f: (30) 210 363 0332 rad@britishcouncil.gr CARIBBEAN (Jamaica, Dominican Republic, Bahamas, Trinidad and Tobago, Barbados, St Lucia and Antigua) Diane C Bernard Royal Academy of Dance PO Box 1433 8 Rockhampton Drive Kingston 8 Jamaica t/f: (001) 876 755 0612 dianebernard@rad.org.jm Version 2, June 2015 HONG KONG Hong Kong Examinations & Assessment Authority International and Professional Examinations Division 17 Tseuk Luk Street San Po King, Kowloon Hong Kong t: (852) 3628 8761 f: (852) 3628 8790 ie7@hkeaa.edu.hk INDONESIA Lala Salendu Yayasan Royal Academy of Dance Indonesia Jl.Angur III no: 1 Cipete Jakarta Selatan 12410 Indonesia t: (62) 21 75 90 93 63 f: (62) 21 75 90 93 70 radindonesia@cbn.net.id REPUBLIC OF IRELAND Beverley Dinsmore Royal Academy of Dance Holly Lodge Pidgeon House Lane Julianstown Co. Meath Ireland t: (353) 419 811 915 bdinsmore@rad.ie ISRAEL Gali Zamir Royal Academy of Dance Hadar Str. 491 Neve Yamin Israel. t: (972) 52 3343 838 gali@rad.org.il ITALY Manuela de Luca Royal Academy of Dance Srl Via Vannetti 12 38122 Trento Italy t: (39) 0461 985 055 f: (39) 0461 985 054 info@raditaly.it www.raditaly.it JAPAN Noriko Kobayashi Royal Academy of Dance Commerce Building 5F 2-39-3 Mejiro Toshima-Ku Tokyo 171-0031 Japan t: (81) 3 3987 3750 f: (81) 3 3987 3649 radjapan@nifty.com MALAYSIA Zafriah Ahmad RAD Dancing (Malaysia) Sdn Bhd 43 Jalan BU 7/ 7 Bandar Utama 47800 Petaling Jaya Selangor Malaysia t: (60) 3 6259 4641 radmalaysia@gmail.com MALTA Sandra Mifsud 8 Guze Ellul Mercer Street Sliema Malta SLM1281 t: (356) 7993 8584 info@radmalta.org www.radrmalta.org Royal Academy of Dance® is a Charity Registered in England & Wales No. 312826 MEXICO, EL SALVADOR, HONDURAS, COSTA RICA, GUATEMALA, PANAMA Julieta Navarro Royal Academy of Dance de Mexico AC Amates 18, Fracc alconfores San Mateo, Naucalpan CP 53240, Mexico t: (52) 55 5360 2700 f: (52) 55 5373 4069 radmexju@prodigy.net.mx NEW ZEALAND Royal Academy of Dance Level 5 Outwide House, 61-63 Taranaki Street, Wellington 6011 New Zealand t: (64) 4 382 8924 f: (64) 4 382 8200 info@rad.org.nz www.rad.org.nz info@rad.org.nz www.rad.org.nz SOUTH KOREA Hyun Joo Ham # 1703 Artnouveau Palace 7-1 Songpa Dong Songpa Gu Seoul 138-848 Korea t/f: (82) 2 532 1910 hjham@radkorea.org www.radkorea.org SPAIN, GIBRALTAR & ANDORRA Maria José Antón Royal Academy of Dance SL Ventura i Gassol 3, 5è-3a 43203 Reus,Tarragona Spain t: (34) 977 34 24 89 t/f: (34) 977 34 19 35 info@rad.org.es www.rad.org.es NORWAY, SWEDEN & DENMARK Karina Lund Smedstuveien 25 7040 Trondheim Norway t: (47) 979 592 0812 klund@royalacademyofdance.no www.royalacademyofdance.no PHILIPPINES Lauren Ann Pascua Examinations Services Officer The British Council 10F Taipan Building F Ortigas Jr. Road, Ortigas Centre Pasig City 1605 Philippines t: +63 (2) 5553041 ext 141 f: +63 (2) 5553080 or +63 (2) 5553090 lauren.pascua@britishcouncil.org.ph PORTUGAL Margarida Sa Fialho Royal Academy of Dance Rua 4 Infantaria 86 1350-241 Lisboa Portugal t/f: (351) 21 383 1849 radportugal@rad.org.pt SINGAPORE Mona Lim Royal Academy of Dance Singapore Pte Ltd, Farrer Road Post Office PO Box 106 Singapore 912804 t: (65) 6762 8993 f: (65) 6762 4031 mona.lim@rad.sg www.rad.sg Version 2, June 2015 SOUTH AFRICA, BOTSWANA, KENYA, MAURITIUS, MOZAMBIQUE, NAMIBIA, SWAZILAND & ZIMBABWE Royal Academy of Dance PO Box 200, Bramley 2018 Johannesburg South Africa t: (27) 11 887 0459 f: (27) 11 887 0561 info@rad.org.za www.rad.org.za SOUTH ASIA Ranmali Mirchandani 40A, Lake Gardens Off Lake Drive Rajagiriya 10100 Sri Lanka t: (94) 777 349399 radsouthasia@gmail.com TAIWAN Shu-Yu Lin 5F, No 122, Sect 7 Chung Shan N. Road Taipei 11151 Taiwan t: (886) 22 871 5615 f: (886) 22 874 7783 linshuyu82@hotmail.com www.rad.org.tw TURKEY Merve Kalyoncu The British Council Maya Akar Centre No 100 - 101 Buyudere Cad Esentepe 80280 Istanbul Turkey t: (90) (0)212 355 5657 f: (90) (0)212 355 5659 merve.kalyoncu@britishcouncil.org.tr UNITED ARAB EMIRATES, BAHRAIN, QATAR & OMAN Shabnam Habib Examinations Services Manager The British Council PO Box 1636 Dubai U.A.E. t: 971 (0)4 3135568 m: 971 (0)4 3370703 f: (971) 4 3370703 shabnam.habib@ae.britishcouncil.org www.britishcouncil.org/uae UNITED STATES OF AMERICA Royal Academy of Dance Marian Center for Non-profits 3211 South Lake Drive, Suite R317 St Francis 53235 Wisconsin USA t: 00 1 414 747 9060 f: 00 1 414 747 9062 info@radusa.org www.radusa.org UNITED KINGDOM Membership Officer (CPD) The Membership Department Royal Academy of Dance 36 Battersea Square London SW11 3RA UK t: 44 (0) 20 7326 8022 f: 44 (0) 20 7924 3129 membership@rad.org.uk www.rad.org.uk THAILAND Glenn van der Hoff RAD Dancing (Thailand) Co.Ltd 121/12, Moo 10, Changmai-Hangdong Road Tambon: Pae Dad Ampur: Muang Chiang Mai 50100 Thailand t/f: (66) 0 5327 4841 m: (66) 08 515 64 562 (office hours) radthailandglenn@gmail.com www.radthailand.org Royal Academy of Dance® is a Charity Registered in England & Wales No. 312826