This is the application process for recognition of INR training by CCINR. Please read this page carefully and make sure that you have ALL the relevant documentation available,  and have completed the fee payment form, before you submit this form. 

Forms required for this application can be downloaded from this page.

The accompanying documentation and fee payment form must be emailed to  CCINR@ranzcr.edu.au and cc'd to info@ccinr.org.au

Name *
Name
Enter your postnomials here (MBBS, FACS etc)
Please enter your address for correspondence
Your current position description, include whether full time or part time, start date
Affiliation *
Tick the appropriate box and submit written evidence of your affiliation
Medical Registration *
Submit evidence of your Medical registration
Training Service Requirements *
You must submit evidence from your Supervisor(s) that the Training Service(s) you were attached to meets the standards set out in Section (3) of the CCINR Guidelines.
Experiential requirements *
You must supply information confirmation the duration and composition of formal training in INR
Supervisor Confirmation of Training *
You must submit written confirmation of your training from an appropriately credentialed supervising INR (see Section 5.2) confirming each subsection of Section 5.3. In addition, each of your Supervisors must complete a Supervisors Declaration form.
Cover letter *
You must supply a cover letter with your application, outlining your training period. It is particularly important to indicate periods of overseas training, and any breaks in training you may have experienced.
Curriculum Vitae *
You must submit a copy of your curriculum vitae with your application
Applicant Declaration *
You must download, read, sign and return the Applicant Declaration
Application Fee *
You must download, complete and return the application fee form