SHORT TERM TRAINING APPLICATION FORM
The short term training in medical specialty mechanism allows internationally qualified specialists or
international specialists in training to undertake short term training in Australia without having to
complete the AMC examination or to have a full comparability assessment done by the relevant
specialist college.
The following documents must be submitted with this application form:
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Current CV
Letter of confirmation from the relevant specialist college as to your fellowship or equivalent status;
or
Letter of Confirmation from the training provide as to your training status;
Details of the proposed training program and the agreed learning outcomes;
Confirmation from the host university/hospital/practice as to arrangement for the placement; and
Section E of the AHPRA application form
Candidates must provide sufficient evidence to enable ACRRM to establish that the position is a genuine
training position which is appropriate and that the supervision and support is adequate. The candidate
must also provide sufficient evidence to enable ACRRM to establish if you are genuine specialist in
training or internationally qualified specialist.
Section Two
APPLICANT DETAILS
Family name:
(Surname)
Given names:
Date of birth:
Male
Female
DD/MM/YYYY
Country of birth:
Address:
State:
Postcode:
Country:
Home phone:
Work phone:
Mobile:
Facsimile:
Email address:
ACRRM Short Term in Training
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HOST AND PLACEMENT DETAILS
Host/placement name:
(University/Practice/Hospital)
Placement:
Duration:
Address:
State:
Postcode:
Contact Person:
Work Phone:
Mobile:
Email address:
Supervisor:
Qualifications:
Work Phone:
Mobile:
Email address:
Section Two
In no more than 300 words please provide an overview of proposed training program, your expected learning
outcomes and details on how these learning outcomes will be measured.
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ACRRM Short Term in Training
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Section Three - Short Term Training Fee
PAYMENT OPTIONS
An assessment fee of $650 applies to this application.
1.
Payment via Credit Card
Card No:
 Visa  MasterCard
   
Expiry Date:
/
Credit Card Type:
Card Holder Name
Signature
Total Amount Due: $650.00
2.
Direct Deposit
Please note that there maybe are additional fees associated with this option, please contact ACRRM BEFORE making a direct
deposit payment.
Account Name:
ACRRM
BSB:
034 003
Account Number:
264 808
Reference:
Full name to be entered
3.
Cheque or Money Order
Please make payable to Australian College of Rural and Remote Medicine
Submitting your application:
Please forward your completed application together with required supporting documentation and
payment to:
Short Term Training
Australian College of Rural and Remote Medicine
GPO Box 2507
Brisbane Qld 4001
Australia
Or email to img@acrrm.org.au
ACRRM Short Term in Training
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