OTP Phase 1 Application Form

OTP Phase 1 Application

"*" indicates required fields

Order ID*

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

Personal Details

Your Name*

Prefix First Last

Date of Birth*

Your Email Address*

Your Phone Number*

Your Postal Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

ID check (certified copy of passport or proof of identiy)*

Accepted file types: jpg, gif, png, pdf, Max. file size: 16 MB.

Must be a Certified Copy.

Upload Photo (optional)

Accepted file types: jpg, gif, png, jpeg, Max. file size: 16 MB.

Overseas Professional Experience

Job Title

Start Date

End Date

Hospital / Company Name

Hospital / Company Address

Manager's Name

Manager's Contact Phone

Manager's Contact Email

Upload certified letter of attestation from Head of Perfusion Department*

Max. file size: 32 MB.

If Head of Department – see OTP policy for alternative letter option.

Upload certified letter from senior cardiothoracic surgeon at overseas hospital*

Max. file size: 32 MB.

Upload signed letter from Head of Cardiothoracic unit*

Max. file size: 32 MB.

Upload CV*

Max. file size: 32 MB.

Education & Certification Details

Describe your education and certification details

Highest level of education*

Select Qualification from List*

If the degree you have completed is not on this list, formal AQF assessment is required. Please apply for this at https://internationaleducation.gov.au/services-and-resources/services-for-individuals/qualifications-assessments/pages/qualification-assessment.aspx

Degree Details – Country*

Degree Details – Institution*

Perfusion Degree*

Upload certified copy of degree*

Max. file size: 32 MB.

Please see the OTP Policy for the current academic standard requirement

Upload certified copy of full academic transcript (with individual units of study listed)*

Max. file size: 32 MB.

Upload copy of other degree(s)

Max. file size: 32 MB.

Select country of certification*

Upload certified copy of perfusion certification*

Max. file size: 32 MB.

Date CCP conferred*

Date CCP expires*

Upload certified letter of attestation from perfusion governing body*

Max. file size: 32 MB.

Must be dated within 6 months and confirm ≥36 months certification, current good standing, competency/CPD/recency compliance, and absence of relevant conduct/ethical/legal issues.

Upload logbook of last 3 years of bypass cases (minimum 150 cases)*

Max. file size: 32 MB.

Format: 150 CPB cases as primary perfusionist in the immediately preceding 36 months, minimum 50/year, official hospital or certifying-body documentation, appropriately verified, excluding trainee/pre-certification cases, showing date, type and role.

Describe your certification renewal and currency requirements*

Please describe how your current perfusion certification is maintained and renewed, including whether renewal is automatic and whether there are ongoing requirements such as continuing professional development (CPD), minimum clinical activity, recertification, or other currency requirements.

Official Translation of Documents

Upload any document supplied which is not in English, in both the original language and translated into English in accordance with the Translated Documents Policy.

Max. file size: 32 MB.

English Language Proficiency

Upload English Language Proficiency Certificate

Max. file size: 32 MB.

As per the OTP Policy.

Prospective Employment

Progression through this pathway requires employment in Australia or New Zealand. If you do not progress with your application due to inability to secure employment within the timeframe included within the OTP Policy, you will be required to reapply.

Please provide prospective employer details here

Upload the offer of employment letter from the prospective employer

Max. file size: 32 MB.

OTP Pathway Acknowledgements

Phase 1 Interview

I understand that if my submitted documentation demonstrates that the minimum Phase 1 eligibility requirements have been met, I will be required to attend a mandatory Phase 1 interview with the ANZBP before my Phase 1 assessment can be completed.*

Yes

I understand that successful completion of the Phase 1 documentary assessment does not, by itself, confirm my eligibility to progress to Phase 2.*

Yes

Pathway Allocation

I understand that the ANZBP will determine the OTP pathway applicable to me following assessment of my Phase 1 application and interview.*

Yes

I understand that I do not select my own Category A or Category B pathway and that pathway allocation is determined by the ANZBP in accordance with the current OTP Policy.*

Yes

I understand that if I am placed as a Category B, I am required to enrol in and successfully complete an ANZBP-recognised formal academic program as part of my OTP pathway at my own or my employers expense before I am eligible to progress to Phase 3.*

Yes

Phase Fees

I understand that separate fees may apply to each phase of the OTP pathway, including Phase 1, Phase 2 and Phase 3, and that payment of a fee for one phase does not cover the fees associated with subsequent phases.*

Yes

I understand that OTP pathway fees are set by the ANZCP and may change from time to time, and that I am responsible for referring to the current published fee schedule.*

Yes

I understand that payment of an OTP pathway fee does not guarantee successful completion of that phase, progression to the next phase, or eventual OTP (ANZ) certification.*

Yes

Adherence to Policy Timelines

I understand that the OTP pathway is time-limited and that I am required to progress through each phase within the timeframe applicable to my allocated pathway.*

Yes

I understand that, once I am eligible for Phase 3, I am expected to present for the ANZBP OTP Board Examination within the timeframe specified by the OTP Policy and at the applicable scheduled examination sitting.*

Yes

I understand that choosing not to present for an available examination sitting does not automatically entitle me to defer my examination or extend my OTP pathway timeframe.*

Yes

I understand that if I do not progress through the OTP pathway within the required timeframe, my existing application may be closed and I may be required to submit a new OTP application under the policy and requirements in force at that time.*

Yes

Acknowledgement of Mandatory Declaration and OTP Policy

Upload a Certified Copy of your completed and signed Mandatory Declarations **

Max. file size: 32 MB.

By signing and uploading this document, I hereby agree to comply with all requirements.

Upload signed copy of current OTP Policy.*

Max. file size: 32 MB.

By uploading this, I confirm that I have read and understood the current ANZCP Overseas Trained Perfusionist Policy.

Upload proof of Phase 1 Payment*

Max. file size: 32 MB.

Applicant Agreement*

I, the undersigned, hereby state I have undertaken the Clinical Activity and Professional Activity, as provided by me and herewith supplied. I declare, • I have read and understood the ANZCP Code of Ethical Practice; the ANZCP Code of Professional Conduct, and the ANZCP Mandatory Declarations Policy. I undertake to abide by these professional standards. • I have not been convicted, nor currently facing charges in any court in Australia and New Zealand, or elsewhere, of any offence punishable by imprisonment for a term of 3 months or longer. • I know of no information that could cause the Australian and New Zealand College of Perfusionists not be satisfied that I am fit to practice and am a competent person to be a certified member of ANZCP. • All information I have provided is true and correct to the best of my knowledge. • I agree to notify ANZCP if information relating to any of the above changes as soon as practical. • I understand that a false declaration will result in review by the Complaints Committee.

OTP Phase 1 Application Form