AMC MCQ Bridging Program Application 2014.1
(NEW SOUTH WALES)
Multiple Choice Questions (MCQ) / SERIES 1Commencement date:
Saturday, February 1, 2014
Weekend workshops:
Saturday, February 1
Saturday & Sunday, March 8 and 9
Saturday & Sunday, April 5 and 6
2. Where did you first hear about our Bridging Program?
RACGP/gplearning Website
Hospital/University notice / Friday Facts
Doctor Connect Website / Australian Medical Council
Word of Mouth – Please Specify
------
3. Participant Details
Family name
First Name / Other Names
Preferred Given Name
Mailing Address Home Work other
State / Postcode
Phone No: (Home) / (Work) / mobile
Fax No / home work / e-mail
Male Female / Date of Birth / / / Country of Birth
4. Emergency Contact
Contact Person ______/ Phone No ______
5. Medical work experience
Please provide which specialty areas you have worked in since graduation & length of time in each:
Paediatrics ______Oncology ______General Practice ______
Emergency ______Obstetrics/Gynaecology ______Other ______
Surgery (type)______General Medicine ______Other ______
What area/specialty of medicine do you wish to pursue in the future?______
6. Qualifications
University of graduation (please include country)
______ / Qualification
______/ Year of completion
______
7. AMC MCQ Examination Results
Have you ever attempted any components of AMC MCQ examination? / Yes No
Did you pass? / Yes No
If yes, please indicate the year in which you last sat the exam? / Yes No
Please indicate the number of attempts / 1 / 2 / 3 / 4 / 5+
8. Dietary Requirements
Could you please tick () which meal choices you enjoy
Meat / Vegetarian / Please specify any allergies: e.g. Peanuts/Gluten free:
Are there any meats that you cannot consume for dietary or religious reasons?
9. Using the Internet
Do not be concerned if you feel that you are not very experienced using the internet. The gplearning website is very easy to use and we have had doctors with varying levels of internet and computer skills undergo the program previously.
You will need an email address and this must be supplied on this application form – if you do not have an email address, please arrange one prior to sending your forms in. On the first day you will be provided with details of how to access the website and your login details for the site, along with other material you may find helpful in the early stages of your participation on the program.
The website is supported by a ‘help desk’ if you ever have any questions – and the details of this will be given to you at the first face-to-face workshop. Internet Explorer is the preferred browser.
**PLEASE VIEW THIS BROWSER INFORMATION BEFORE DOING THE MOCK EXAMS**
We recommend participants use the following Internet browsers:
Windows: Google Chrome or Internet Explorer versions 7 and 8 (not version 10)
Macintosh: Google Chrome only
We strongly recommend participants not use any other browsers as this will have an effect on your assessment and may result in answers not being submitted.
10. Code of Conduct
Participants of the Royal Australian College of General Practitioners (RACGP) AMC Bridging Program and the staff of the RACGP are expected to adhere to appropriate standards of workplace behaviour. Program participants have a right to study in an environment free from intimidation or harassment. The ground rules communicated at the beginning of the program by the Educator must be adhered to. We expect you to conduct yourself as a professional and behave courteously towards other class members and staff.
If objectively, a participant becomes ‘unduly disruptive’* and disrespectful of others; the Medical Educator will give the person a verbal warning. If the person persists with this behaviour they will be asked to leave the building. The Medical Educator will report the situation to the Program Manager. It is in the discretion of the Program Manager whether this person will be permitted to continue to participate in the program sessions.
The RACGP reserves the right to refuse a person, who has previously been asked to leave a program, to participate in any future programs run by the RACGP in Australia
*For the purposes of this Code of Conduct, ‘unduly disruptive’ may mean that the participant interferes with the class progressing at an acceptable pace. It may mean something less than such as unreasonably interjecting during classes, or argumentative, or aggressive conduct which impedes rational discussion or offends other program participants. This illustration of unacceptable behaviour is to provide guidance only and is not attended to be an exhaustive definition of the terms used.
11. Minimum Number Requirements
The program requires a minimum number of participants to run. If we do not reach our minimum number of participants for a program, then the program may have to be cancelled.
12. Payment Options
Payment of Course Fee in FullUpfront– This Payment can be made via Credit Card, Bank Cheque or Money Order.
Please complete the Full Payment Form on page 4 of this application form.
13. Payment
Payment of Course Fee in FullUpfront– This Payment can be made via Credit Card, Bank Cheque or Money Order.
Please complete the Full Payment Form on page 5 of this application form.
Payment of Course Fee in Instalments – This payment can be made via Credit Card only. Full payment must be received before the course commences.
Please complete the Instalment Payment Form on page 6 of this application form
Details of the Instalment Plan
Pl e Please note: Instalment payments are only possible if applications are lodged minimum 4 weeks prior to the Bridging Pro Program commencement. Any applications received after this requires full upfront payment.
An initial payment for $ 995 is payable when the Application Form is forwarded to the RACGP.
The second Instalment and third instalments of $1,500 each will be deducted from your credit card on the date stated in the instalment table on the Instalment Payment Form (Page 6).
By signing the payment form, you acknowledge that you have given permission to the RACGP to deduct the second and third instalments when the payments are due.
By signing the payment form, you acknowledge that you have given permission to the RACGP to create a payment form to deduct the second and third instalments when the payments are due.
Please be aware that if the last instalment cannot be deducted successfully before the course commences, you will not be able to attend the course. Once the course has commenced, late payments will not be accepted.
Please call us if you wish to discuss this further.
14. Cancellation/Withdrawal Policy
A full refund of the registration fee will apply provided that written notice is received by the RACGP at least four (4) weeks prior to the start of the workshop date.
If a participant, whether paying full fee upfront or in instalments, cancels their registration less than two (2) weeks prior to the start of the workshop date, the RACGP will deduct 10% of the full registration fee.
If the RACGP is unable to deduct the last instalment of the registration fee less than two (2) weeks prior to the start of the workshop date, the RACGP will refund monies already received minus 10% of the full registration fee.
If a participant transfers their application to another series less than two (2) weeks prior to the start of the workshop date, the RACGP will deduct a 10% administration fee.
If a participant cancels their registration during the program, there will be no refund.
The Registrant acknowledges that the cancellation fee is not a penalty but a genuine pre-estimate of the loss and administrative consequences caused by late cancellation
15. Declaration
I understand:
- the offer of a place in this program is not guaranteed as it is subject to state quotas and selections
- participation in this program does not guarantees success for AMC candidates with respect to any AMC Examination Process
I have read and understand the terms of the Cancellation/Transfer policy in Section 14 on this application form.
Signature______Print Name______Date ______
16. Checklist
Please ensure that you have completed / attached the following:
ELIGIBILITY AND SUPPORTING DOCUMENTATION REQUIRED
MCQ Bridging Program Candidates:
A letter from the AMC stating that you are eligible to sit the AMC Exams or a copy of your most recent AMC MCQ results.
If arriving from overseas for the course, or not a permanent resident of Australia, we require a photocopy of your immigration Visa that you have been granted. All immigration Visas must be valid for the entire duration of the bridging program or we are unable to accept your registration.
Please note: We are unable to hold places for overseas residents who have not been granted a visa or are awaiting a visa.
Copy of either your Occupational English Test (OET - Academic) or the International English Language Testing System (IELTS), indicating your average result (an OET overall B grading or a Band 6.5 with no score below 6 in the IELTS system) or a letter of exemption from the AMC. When applying to sit the Australian Medical Council Exam, please check the AMC website as to the English language test requirement.
Payment Form with Payment
It is mandatory that on the first day of the bridging course commencement all participants arriving from overseas must provide the RACGP with Australian contact details including an address and mobile phone number.
It would be advisable to take a copy of this form for your records and to keep a copy of the contact details:
Contact details:
AMC Bridging Program, RACGP, 100 Wellington Parade,
East Melbourne, VIC 3002
Email: ; F:(03) 8699 0588
Enquires Please call 1800 284 732
Full PaymentForm/Tax Invoice
AMC MCQ Bridging Program 2014.1 NSW
Applicant DetailsFirst Name : /
Family/
Last name:Address :
Post Code : / RACGP NO.
( if known)
Please Select Series / Program Description / Cost
2014.1 / AMC MCQ Bridging Program - 10 weeks of MCQs, 3 weekend workshops& 2 Trial Exams / $ 3,995
Payment Details
Cheque or Money Order
(made payable to “Royal Australian College of General Practitioners”
or “RACGP”)
Visa Master Card AMEX
Card No: _ _ _ _/_ _ _ _/_ _ _ _/_ _ _ _ Expiry Date: _ _ / _ _
Cardholder Name: (As it appears on the credit card) ___
Signature: Amount:
Your enrolment for all RACGP Bridging Programs for International Medical Graduates cannot be secured until full payment is received.
Applicants are advised to consult their financial adviser on the tax benefits available for engaging in vocational training and education.
Please forward your Application form, supporting documents and payment by post, email or fax to:
AMC Bridging Program, RACGP, 100 Wellington Parade, East Melbourne, VIC 3002
Email: ; Fax: (03) 8699 0588
Enquires Please call 1800 284 732
APPLICATIONS MUST BE RECEIVED AT LEAST 2 WEEKS
PRIOR TO THE COMMENCEMENT OF THE PROGRAM
FOR OFFICE USE ONLY
RACGP No (Bill To)
/ Batch No
/ Order No / Invoice No
Instalment Payment Form/Tax Invoice
AMC MCQ Bridging Program 2014.1 NSW
Applicant DetailsFirst Name : / Family/
Last Name:
Address :
Post Code : / RACGP NO.
( if known )
Please note: Instalment payments are only possible if applications are lodged minimum 4 weeks prior to Bridging Program commencement. Any applications received after this requires full upfront payment.
Please Select series / Program Description / Cost2014.1 / AMC MCQ Bridging Program / $3,995
Date of Instalment / Instalment Amount
With application / $995
January 6, 2014 / $1,500
January 17, 2014 / $1,500
Payment Details
Visa Master Card AMEX
Card No: _ _ _ _/_ _ _ _/_ _ _ _/_ _ _ _ Expiry Date: _ _ / _ _
Cardholder Name: (As it appears on the credit card) ___
Signature: Amount: $ ___
Your enrolment for all RACGP Bridging Programs for International Medical Graduates cannot be secured until full payment is received.
Applicants are advised to consult their financial adviser on the tax benefits available for engaging in vocational training and education.
Please forward your Application form, supporting documents and payment by post, email or fax to:
AMC Bridging Program, RACGP, 100 Wellington Parade, East Melbourne, VIC 3002
Email: ; F:(03) 8699 0588
Enquires Please call 1800 284 732
APPLICATIONS MUST BE RECEIVED AT LEAST 2 WEEKS
PRIOR TO THE COMMENCEMENT OF THE PROGRAM
FOR OFFICE USE ONLY
RACGP No (Bill To)
/ Batch No
/ Order No / Invoice No