Forms

Click on the tabs below to access forms. Please contact the College if you have any queries. 

CPD (5)

CPD Accreditation
Last updated January 2016

http://acem.org.au/getattachment/d672b9ca-8f02-4ece-8645-3e9f5c03cd3d/CPD-Accreditation.aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
PDF 727 kB
CPD Active Peer Review
Last updated November 2014  

http://acem.org.au/getattachment/18a859c9-e3e1-4465-a55d-713b86cb883b/CPD-Active-Peer-Review.aspx
Added: Dec 2, 2013 Last Updated: Nov 20, 2014
DOCX 217 kB
CPD Audit of Medical Practice
Last updated July 2016

http://acem.org.au/getattachment/177730fe-53d2-442c-8217-c29b26f08651/CPD-Audit-of-Medical-Practice.aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
PDF 613 kB
CPD Exemption
Last updated November 2014

http://acem.org.au/getattachment/dc350d37-bdc1-438e-8075-457db012d829/CPD-Exemption.aspx
Added: Dec 2, 2013 Last Updated: Nov 20, 2014
DOCX 212 kB
CPD Retrospective Peer Review
Last updated November 2014 

http://acem.org.au/getattachment/28b002a5-69e2-438c-a427-4123e911d4a5/CPD-Retrospective-Peer-Review.aspx
Added: Dec 2, 2013 Last Updated: Nov 20, 2014
DOCX 218 kB

DEMT (2)

Form 41 DEMT Appointment-Resignation
Last updated December 2013

http://acem.org.au/getattachment/b566128b-0b0c-44d0-9031-3a675978abaa/DEMT-Appointment-Resignation.aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
PDF 372 kB
Form 42 DEMT Leave Form
Last updated December 2013

http://acem.org.au/getattachment/b955926a-d7cd-4110-a234-d52db70a208d/DEMT-Leave-Form.aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
PDF 352 kB

Education (30)

TA493 Special Consideration Application Form (DOCX)
Added 24 May 2016

http://acem.org.au/getattachment/ef2136bb-a590-4e02-adde-d91a76756feb/TA493-Special-Consideration-Application-Form-(DOCX.aspx
Added: May 24, 2016 Last Updated: May 24, 2016
DOCX 254 kB
TA493 Special Consideration Application Form (PDF)
Added 24 May 2016

http://acem.org.au/getattachment/80b99da3-0128-43fe-a1b8-2ae1d5e2ce52/TA493-Special-Consideration-Application-Form-(PDF).aspx
Added: May 24, 2016 Last Updated: May 24, 2016
PDF 517 kB

-Enrolment (6)

TA150A Trainee Enrolment Form - Part A
Last updated October 2016

http://acem.org.au/getattachment/41e9ef80-54be-46e2-bc38-e524264b37be/Application-for-Trainee-Registration.aspx
Added: Dec 2, 2013 Last Updated: Oct 13, 2016
PDF 440 kB
TA150B Trainee Agreement - Part B
Uploaded 6 September 2016

http://acem.org.au/getattachment/064c82a4-f589-4847-b13c-9c58255c0e9c/TA150B-Trainee-Agreement-Part-B.aspx
Added: Sep 6, 2016 Last Updated: Sep 6, 2016
PDF 316 kB
TA149 Application for Trainee Re-Enrolment - Part A
Updated 13 October 2016

http://acem.org.au/getattachment/15699700-f104-47b2-a499-09442dbdf61c/Application-for-Approval-to-Reregister.aspx
Added: Dec 2, 2013 Last Updated: Oct 13, 2016
PDF 298 kB
PEM151 Application for PEM Joint Training Program
Currently under review 

http://acem.org.au/getattachment/34f1ea36-5da6-46e4-8781-5ff90c99356a/PEM151-Application-for-PEM-Joint-Training-Program.aspx
Added: Dec 4, 2014 Last Updated: Dec 4, 2014
PDF 365 kB
NSC223 Application for Certificate
Updated 30 June 2016

http://acem.org.au/getattachment/e825efce-3dbd-45d6-abb5-f0833215af00/Application-for-Certificate.aspx
Added: Dec 2, 2013 Last Updated: Oct 13, 2016
PDF 1.9 MB
NSD224 Application for Diploma
Updated 13 October 2016

http://acem.org.au/getattachment/ee32f7b4-fbe3-4552-a7b0-dbf80f4b685a/Application-for-Diploma.aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
PDF 542 kB

-Credit Transfer (4)

TA162 Verification of Completion
Currently under revision


http://acem.org.au/getattachment/91f332c5-289b-430c-b938-a1ef6456b123/Basic-Training-Credit-Transfer.aspx
Added: Dec 2, 2013 Last Updated: Dec 4, 2014
PDF 514 kB
TA163 Non- ED Provisional Training Credit Transfer
Currently under revision  


http://acem.org.au/getattachment/4f92f222-13da-48fe-86a5-f7dbeaeabe05/Provisional-Training-Credit-Transfer.aspx
Added: Dec 2, 2013 Last Updated: Dec 4, 2014
PDF 379 kB
TA164 Primary Exam Subjects Credit Transfer
Currently under revision  

http://acem.org.au/getattachment/86dfa4c6-4d90-410a-acb6-349bf29cc9a4/Primary-Exam-Subjects-Credit-Transfer.aspx
Added: Dec 2, 2013 Last Updated: Dec 4, 2014
PDF 377 kB
TA165 Advanced Training Credit Transfer
Currently under revision  

http://acem.org.au/getattachment/11de937f-cf8a-45ed-a2b6-3dae15480e8e/Advanced-Training-Credit-Transfer.aspx
Added: Dec 2, 2013 Last Updated: Dec 4, 2014
PDF 363 kB

-Administration (3)

TA168 Application for Election to Fellowship
Updated 22 February 2017

http://acem.org.au/getattachment/1769e458-a994-42cf-a7bf-0da0348a08b2/Application-for-Election-to-Fellowship.aspx
Added: Dec 2, 2013 Last Updated: Feb 22, 2017
PDF 186 kB
TA167 Change of name details
Last updated 3 December 2016  

http://acem.org.au/getattachment/725cad52-6f21-4ea1-8222-6a27d550dd21/Change-of-name-details.aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
PDF 982 kB
CF171 Interruption of Training / Annual Fee Concession 2017
Last updated 28 November 2016

http://acem.org.au/getattachment/29e94a19-c11f-4a05-af43-69baa885d57a/Interruption-of-Training-Annual-Fee-Concession-201.aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
PDF 161 kB

-Approval of Training Posts (6)

TA158 Approval for OS Completion of Paediatric Logbook
Currently under revision  

http://acem.org.au/getattachment/80f8a00d-b444-4c35-ba4d-c53f1f3651de/Approval-for-OS-Completion-of-Paediatric-Logbook.aspx
Added: Dec 2, 2013 Last Updated: Dec 4, 2014
PDF 331 kB
TA157 Approval of Proposed Overseas Training
Currently under revision  

http://acem.org.au/getattachment/d8c33fa6-20f8-4f46-af30-651c3aad9eb3/Approval-of-Proposed-Overseas-Training.aspx
Added: Dec 2, 2013 Last Updated: Nov 14, 2016
DOCX 58 kB
TA155 General Practice (RACGP or RNZCGP)
Currently under revision  

http://acem.org.au/getattachment/b0354da6-7f3e-430e-a3ad-6a4b0cd389c2/General-Practice-(RACGP-or-RNZCGP).aspx
Added: Dec 2, 2013 Last Updated: Dec 4, 2014
PDF 989 kB
TA245 Medical Administration (RACMA)
Currently under revision  

http://acem.org.au/getattachment/60476c8b-8fac-41b4-8756-b3188a35779f/Medical-Administration-(RACMA).aspx
Added: Dec 2, 2013 Last Updated: Dec 4, 2014
PDF 282 kB
AC173 SSTIQ Accreditation
Last updated 3 December 2013

http://acem.org.au/getattachment/7c49e358-323b-46cf-95f4-5b246a437e0a/SSTIQ-Accreditation.aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
DOC 185 kB
PEM152 PEM Joint Training Program- Notification of Term Details
Currently under review

http://acem.org.au/getattachment/29b471e0-8f1c-4c6d-b276-1476646f4c36/PEM152-PEM-Joint-Training-Program-Notification-of.aspx
Added: Dec 4, 2014 Last Updated: Dec 4, 2014
PDF 208 kB

-Assessment (9)

TA169 Annual Record of Training (Basic Training)
Currently under revision  

http://acem.org.au/getattachment/0e2b3ff2-ca55-4671-9246-1b2ce9572089/Annual-Record-of-Training-(Basic-Training).aspx
Added: Dec 2, 2013 Last Updated: Dec 4, 2014
PDF 440 kB
Application form – Presented Project
Updated 3 January 2017

http://acem.org.au/getattachment/e938e05c-fa4b-4c17-a0bc-5716beabff86/Application-for-Adjudication-–-Presented-Project.aspx
Added: Dec 2, 2013 Last Updated: Jan 2, 2017
PDF 609 kB
Application form – Published Project
 Last updated 2 January 2017 

http://acem.org.au/getattachment/494bbf72-0dfb-44cd-980a-47e75cd2b452/Application-for-Adjudication-–-Published-Project.aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
PDF 582 kB
Application form - Present at a Forum
Last updated 3 December 2014

http://acem.org.au/getattachment/dd6c8dcc-3c01-4c46-92fa-eea687bf3432/Application-for-the-Approval-of-a-Non-College-Foru.aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
PDF 318 kB
Application form - New Coursework Pathway Subject
Updated 3 January 2017

http://acem.org.au/getattachment/50f8797e-181b-45c6-ace8-8500109cb420/Application-form-for-the-Approval-of-a-New-Coursew.aspx
Added: Dec 2, 2013 Last Updated: Jan 2, 2017
PDF 447 kB
TA160 In-Training Assessment (approved OS terms only)
Last updated 3 December 2013

http://acem.org.au/getattachment/f21af751-f3dd-4a48-ae5a-fc69bc85b0a6/In-Training-Assessment-(approved-OS-terms-only).aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
PDF 490 kB
TA170 Notification of First Provisional Training Terms (for Basic Trainees progressing to Provisional Training)
Currently under revision  

http://acem.org.au/getattachment/945775d7-a5ec-4b7e-8bcf-c6457093d651/Notification-of-first-Provisional-Training-terms-(.aspx
Added: Dec 2, 2013 Last Updated: Dec 4, 2014
PDF 974 kB
Assessment form - Trainee Research Project
Updated 20 December 2016

http://acem.org.au/getattachment/0d45f924-336d-4673-a315-d7c92db555c4/Trainee-Research-Project-Assessment-Form.aspx
Added: Dec 2, 2013 Last Updated: Dec 20, 2016
PDF 346 kB
PEM153 In-Training Assessment- FACEM PEM Candidates
Currently under review

http://acem.org.au/getattachment/4570daa1-226c-41a6-99c2-ecb3d455f223/PEM153-In-Training-Assessment-FACEM-PEM-Candidates.aspx
Added: Dec 4, 2014 Last Updated: Dec 4, 2014
PDF 379 kB

Finance (3)

CF339 Request for Refund
Last updated: 15 June 2016

http://acem.org.au/getattachment/0e77cce7-e1db-4438-9f00-e09639c36309/Request-for-Refund.aspx
Added: Dec 2, 2013 Last Updated: Jun 15, 2016
PDF 485 kB
CF172 Application for Concession
Last updated 31 May 2016

http://acem.org.au/getattachment/cadd486d-4635-4cbb-aa0d-2774b6322f2d/Application-for-Concession.aspx
Added: Dec 2, 2013 Last Updated: Feb 2, 2017
PDF 367 kB
CF242 Request for Reimbursement
Last updated: 13 Decemeber 2016

http://acem.org.au/getattachment/0715deb7-1c54-410f-a6c9-f683aa6b0fcd/Request-for-Reimbursement.aspx
Added: Dec 2, 2013 Last Updated: Dec 13, 2016
DOCX 223 kB

Governance (3)

Application for reconsideration (DOCX)
Last updated: 29 April 2016

http://acem.org.au/getattachment/70e7b21a-5f11-4049-8504-e6df0049d024/Application-for-reconsideration-(DOC).aspx
Added: Apr 7, 2016 Last Updated: Apr 29, 2016
DOCX 257 kB
Application for reconsideration (PDF)
Last updated: 29 April 2016

http://acem.org.au/getattachment/62a50a63-52b8-4178-af0c-d695aa5e4227/Application-for-reconsideration.aspx
Added: Nov 4, 2015 Last Updated: Apr 29, 2016
PDF 508 kB
Declaration concerning retirement
Last updated 4 November 2015

http://acem.org.au/getattachment/991319e0-0f57-4e7b-92b7-191dd715dbaf/Declaration-concerning-retirement.aspx
Added: Nov 4, 2015 Last Updated: Feb 2, 2017
PDF 411 kB