APPLICATION FOR REGISTRAR TRANSFER /

This application form is used to support a registrars’ transfer between RTOs and/or training pathways. The registrar must complete all relevant sections of the form and provide supporting documents. Refer to ED-Org-16 AGPT Program Transfer procedure for further information.

Complete the following sections and return it along with support documents to

Section A – Registrar details

Name (print name): / AGPT No:
Address:
State: / Post code:
Email:
Mobile: / Home:
Pathway: / General / Rural
If rural pathway, are you subject to the 10 year moratorium? Yes / NoYesNo
Current stage of training: / Hospital year / GPT/PRR1 / GPT/PRR2 / GPT/PRR3
ESP/GPT/PRR4 / ARST/AST / Elective / Fellowship

Section B – Transfer details

Requested RTO:
Transfer type: / Permanent / Temporary
Transfer dates: / Start date: / End date:
Categories: Category 1 / Transfer between RTOs
-  Identified career and/or education and training requirement / Includes extended and advanced skills training
-  Extenuating and unforeseen changes to personal circumstances
-  The RTO is unable to place the registrar due to capacity
Category 2 (a) / Transfer from general to rural pathway / Subject to specific location preferences
(b) / Transfer from rural to general pathway (permanent) / Requires Department of Health approval
-  Identified career and/or education and training requirement / Excludes extended and advanced skills training
-  Extenuating and unforeseen changes to personal circumstances
-  Unforeseen medical condition that precludes the registrar from being adequately or safely managed in their rural location
-  The registrar has received a Section 19AB exemption from the Department of Health and meets one of the above clauses in 2(b)
(c) / Transfer from rural to general pathway (permanent) / Requires Department of Health approval
Category 3 / ADF transfer

Section C – Reason for transfer

Reason for transfer:
Registrars are expected to remain with their current RTO for the duration of training unless under the circumstances as defined in the AGPT Transfer Policy.
Registrars are not automatically entitled to a transfer.
Support documents: / AGPT profile report (available from current RTO) / (required)
(where relevant) / Independent supporting medical evidence
Exemption letter from Department of Health
ADF posting order
Other supporting information

Section D – Registrar declaration

I declare that the information provided here in connection with this application is are correct.
I have read the AGPT Transfer Policy, the ED-Org-8.16 AGPT Program Transfer and ED-Org-8.9 Training Obligation procedures.
I recognise that it is my responsibility to provide all necessary supporting documentation.
I confirm that all registrar commitments will be completed prior to the date of transfer.
I give permission for my training portfolio to be made available/transferred to the requested RTO.
I acknowledge that at any stage, the Department of Health reserves the right to vary or reverse any decision made on the basis of false or incomplete information in this application.
Registrar’s signature: / Date:

Section E – RTO office use only

Details / Host RTO details / Home RTO details
Name: / Eastern Victoria GP Training
Phone number: / 9822 1100
Fax number: / (03) 9822 9011
Email: /
Transfer approval: / Yes No / Yes No NA
CEO or delegate: / David Glasson
Signature:
Date:

Section F – Department of Health use only

Signature: / Director, GP Selection and Education Section, Department of Health / Date:

ED-Form 8.1 Application for Transfer Page 1 of 2