Remote Vocational Training Scheme

Application form forRACGP Recognition of Prior Learning(RPL)

for Hospital and General Practice Experience

Applicant Name:
Address:
Phone Number:(Home)
(Work)
Date of General Registration: / (attached supporting evidence with form)

Section A: Details of posts to be considered for RPL *

Discipline / Location / Dates
From To / Number of Weeks / Hours/
Week

*Attach documentation from the employing hospital/institution to verify experience.

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Section B:Details of other relevant experience

Discipline / Location / Dates
From To / Number of Weeks / Hours/
Week

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Section C:Education Activities

For each discipline/post detailed in Section A supply a logbook of educational activities attended using the following proforma.

Post:
Date / Duration
(Hours) / Organised By / Type of Activity / Relevance to RVTS Training
e.g. 1-3/95 / 1 hour each week / Hospital / Lunch time case discussion / Increasing knowledge of diagnosis and management of common conditions

Section D:Feedback and Formative Assessment

For each discipline/post detailed in Section A supply a description of feedback and formative assessment processes undertaken and attach any written documentation.

Post:
Supervisor:
Description of feedback:
Copy of written feedback/assessment attached: Yes  No 
Post:
Supervisor:
Description of feedback:
Copy of written feedback/assessment attached: Yes  No 
Post:
Supervisor:
Description of feedback:
Copy of written feedback/assessment attached: Yes  No 

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Section E: Referees

The following supervisors can discuss my knowledge and skills with reference to training for general practice.

Post:
Supervisor’s Name:
Address:
Daytime Tel. Number:
Post:
Supervisor’s Name:
Address:
Daytime Tel. Number:
Post:
Supervisor’s Name:
Address:
Daytime Tel. Number:

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Section F:Other Information

F.1Written Essay

  • Attach an essay of 500 words explaining how your experiences have helped you meet the learning objectives of the hospital and general practice components of the RVTS. Essays received by RVTS that are over 500 words will be returned for editing.
  • You should refer to all hospital and general practice experience you have had (detailed in both sections A and B of the application).
  • The essay should make specific reference to the RACGP domains ( and where relevant specific learning objectives as outlined in the RVTS curriculum statement.
  • Short case reports could be used to illustrate key objectives.

F.2Attach other relevant information

eg. conference papers, research grants, publications, committee activity, testimonials etc.

Attachment / Relevance to RPL

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Section G:Declaration

I declare that the information provided by me within this application is true and correct.

I recognise that it is my responsibility to provide all necessary documentation.

I acknowledge that the RVTS reserves the right at any stage to vary or reverse any decision regarding this application where information submitted is found to be incorrect or incomplete.

(Signature of applicant)(Dated)

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