Trainee Registration Form

Only complete this form if you are employed as a clinical perfusion trainee within Australia or New Zealand.

Please ensure you have read the Certification Policy here and have all relevant certified copies of the documents required for uploading prior to commencing your registration.

You will need:

Certified Copy of proof of identity
Certified Copy of degree qualification
Certified Copy of academic transcript

Trainee Registration Form (2026)

Trainee Registration

Registration as an ANZBP trainee is only available to individuals who are currently employed as a clinical perfusion trainee within Australia or New Zealand in an appropriate training environment.

Are you currently employed as a clinical perfusion trainee within Australia or New Zealand in a ANZBP approved training unit?(Required)

Yes

Applicant Details

Name(Required)

First Last

Postal Address(Required)

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

Phone(Required)

Work Email(Required)

Alternate Email

Trainee Employment Details

Hospital/Employer(Required)

Lead Supervisor(Required)

Lead Supervisor Contact Number

Lead Supervisor Email(Required)

Head of Perfusion Department (if different from the lead supervisor)

Is your training shared across two different sites? If yes, please provide details.

It is the responsibility of each trainee to secure and maintain employment in an approved clinical perfusion trainee position for the entirety of their training. Continued enrolment in the academic program is contingent upon maintaining this employment. If a trainee position ceases at any stage during the program, the trainee will be required to take intermission as per Monash University until a new approved trainee position is secured, or otherwise withdraw from the program.

Academic Details

Tertiary Qualifications (List Here)(Required)

Required Documentation

Please ensure all documents are certified as per the Certification Policy prior to uploading here. If your university degree uses MyEquals, please upload a document with the code and link, for verification, and there is then no need to certify those documents if MyEquals is utilised.

Certified Copy of Proof of Identity (Driver's Licence or Passport)(Required)

Max. file size: 32 MB.

Certified Copy of Degree Qualification(Required)

Max. file size: 32 MB.

Certified Copy of Academic Transcript(Required)

Max. file size: 32 MB.

Proof of Current Trainee Employment (contract or letter from Employer)(Required)

Max. file size: 32 MB.

Concurrent Employment and Academic Priorities

The ANZBP training pathway requires trainees to balance employment in a clinical perfusion trainee position with concurrent postgraduate study and completion of clinical and administrative requirements. Before entering the pathway, trainees should carefully consider whether they are able to meet the pressure and demands of both work and study at the same time for a period of 2 to 3 years.

Please provide a response addressing the following: How you plan to manage the demands of employment, study, and training over the course of the program; your understanding of the time and commitment required across both workplace and academic components; whether you have discussed the training commitment with your employer or supervising department; and whether any protected study time, leave, or other workplace support arrangements have been clarified, if applicable.

Funding Arrangements

Trainees are responsible for understanding and managing their own funding arrangements for participation in the training pathway, unless alternative arrangements have been formally confirmed in writing by their employer or another funding body. Depending on individual circumstances, costs may include tuition fees, annual trainee membership fees, examination fees, travel, accommodation, and other expenses associated with training and certification. Once certified there are ongoing costs including recertification, costs required for ongoing professional development and membership of the College.

Who is primarily responsible for payment of your course fees?(Required)

Self-Funded

Employer / Hospital

Shared between trainee and Employer

Other

Do you accept responsibility for any course-related costs not covered by your employer or another funding body? Yes/No(Required)

Clinical Requirements of the Training Program

Please read each statement carefully and tick each box to confirm that you understand, acknowledge, and accept the clinical requirements and progression obligations of the ANZBP local training pathway. These declarations form part of the ANZBP Trainee Registration application, and ANZBP may rely on them when assessing eligibility for trainee registration and ongoing participation in the training pathway.

The applicant declares that for eligibility for Certification (CCP ANZ) they;(Required)

Trainee Acknowledgements

Please read each statement carefully and tick each box to confirm that you understand, acknowledge, accept, or accept responsibility for the relevant requirement. These declarations form part of the ANZBP Trainee Registration application, and ANZBP may rely on them when assessing your eligibility for trainee registration and ongoing participation in the ANZBP training pathway.

The applicant declares that they;(Required)

Mandatory Declarations

Please read each statement carefully and tick each box to confirm that the following declarations are true and correct. These declarations form part of the ANZBP Trainee Registration application, and are required in accordance to the Certification Policy.

The applicant declares that they;(Required)

have read and understood: the ANZCP Rules; the Code of Ethical Practice and Professional Conduct; and the Certification Policy; and agree to abide by their requirements and confirm that they have complied with those requirements.

believe they meet, and will ensure they continue to meet, the relevant Competency Standards applicable to the ANZBP trainee pathway.

are in professional good standing and have no existing restrictions to practise in any country or jurisdiction.

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

have declared, in accordance with the Mandatory Declarations Policy before making this declaration: (a) 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; (b) any pending or completed investigations or disciplinary proceedings, domestically or internationally, and for completed matters, the findings and outcome; and (c) any concerns about other previous non-compliance or an ability to comply with these Mandatory Declarations.

know of no other information that could cause the ANZCP not to be satisfied that they are suitable to participate in the training pathway and are a safe, competent and ethical person to practise as a trainee under supervision.

confirm that all information provided in the application is true, complete and correct to the best of their knowledge.

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

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

Enter Full Name(Required)

The applicant, by entering their full name, declares and agrees that all of the information provided in this application is true and correct.

ANZBP Mentoring Program

I am interested in being part of the ANZBP Mentoring Program.

Trainee Registration Form

Trainee Registration Form (2026)

Trainee Registration

Applicant Details

Trainee Employment Details

Academic Details

Required Documentation

Concurrent Employment and Academic Priorities

Funding Arrangements

Clinical Requirements of the Training Program

Trainee Acknowledgements

Mandatory Declarations

Contact Details

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