CPD Document Submission Portal

Order ID*

The Order ID must correspond to the Order number found on your Recertification receipt/invoice email.

Your Name*

Prefix First Last

Please provide your first and last name as they should appear on your certificate.

Your Email Address*

This is the email address to which your certificate will be sent.

Your Phone Number

Additional Information / Hardship

If you have experienced hardship during this period, the Board will individually assess your request. Please include any information to assist the ANZBP in your assessment. To give the Board the best opportunity to serve you, please ensure you submit your request as soon as possible.

Please submit hardship requests by 1st May. Hardship requests that are received after this date may not be processed by the due date and a certificate of currency may not be issued on time.

Regarding Documents to Upload

Add your CPD Proforma and any supporting documentation for hardship consideration here also.
Please ensure your CPD proforma is populated with data that can be substantiated in the event of an audit.

Upload Document(s)*

Drop files here or

Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 16 MB, Max. files: 10.

Permitted formats: doc, docx, xls, xlsx, pdf. Maximum Filesize 16MB.

Member Status*

I am a current ANZCP Member

I am not a Member

Declarations

As a certified clinical perfusionist applying for recertification, I declare the following:

Declaration 1*

I Agree

I have read and understood the following College documents, agree to abide by their requirements and confirm that I have complied with these requirements in the previous period of certification or provisional certification*

The ANZCP Rules;
The Code of Ethical Practice and Professional Conduct;
The CPD Program;
The ANZCP Certification Policy;
The Recency and Resumption of Practice Policy;
Mandatory Declarations Policy.

Declaration 2*

I Agree

I believe I meet and I will ensure I continue to meet the Competency Standards. *

Declaration 3*

I Agree

I am in professional good standing and have no existing restrictions to practice in any country or jurisdiction. *

Declaration 4*

I Agree

I have complied with any disciplinary or other action imposed on me by the ANZCP, or by any other body of standing to impose such requirements. *

Declaration 5*

I Agree

I have declared:

all charges, convictions or involvement in proceedings related to a criminal offence punishable by imprisonment for a term of three months or longer, domestically or internationally;
any pending or completed investigations or disciplinary proceedings, domestically or internationally, about me and, for completed matters, the findings and outcome; and
any concerns about other previous non-compliance or an ability to comply with these Mandatory Declarations in accordance with the Mandatory Declarations Policy before making this declaration. *

Declaration 6*

I Agree

I know of no other information that could cause the ANZCP not be satisfied that I am fit to practice and am a safe, competent and ethical person to be Certified. *

Declaration 7*

I Agree

I agree to notify ANZCP, as soon as practical, if any information relating to the above Mandatory Declarations changes.*

Declaration 8*

I Agree

I acknowledge that all information provided in this CPD Proforma may be subject to random auditing in accordance with NASRHP standards and the ANZCP CPD Program requirements *

Declaration 9*

I Agree

I understand that if selected for a random audit (minimum 5% of submissions), I will be required to provide supporting documentation to verify all activities claimed in this proforma.*

Declaration 10*

I Agree

All information I have provided in my application is true, complete and correct to the best of my knowledge.*

Declaration 11*

I Agree

I confirm that the activities recorded in this proforma are accurate, complete and reflect my genuine professional development during the CPD year.*

Declaration 12*

I Agree

I understand that failure to comply with CPD requirements or submission of false information may result in removal of certification or provisional certification status*

Declaration 13*

I Agree

I agree to my personal information, as provided in my application and supporting documents, being used for the purposes of processing my application and understand that information may be sought from third parties about my application.*

Enter Last Name (as acknowledgement of declaration)*

CPD Document Submission Portal

Regarding Documents to Upload

Declarations

Contact Details

Quicklinks