Privacy disclaimer: Cunningham Centre is collecting this information in accordance with the National Vocational Education and Training Regulator Act 2011 in order to meet your needs as a client and ensure accurate records are maintained for accreditation purposes. Some of this information may be given to an external agency for the purpose of meeting contractual reporting arrangements. Your information will not be given to any other person or organisation unless authorised or required by law.
Please refer to the application package for details on the admission requirements and application process prior to completing your application form.
List any preference/s of clinicians or facilities you wish to visit. Include reasons for your preferences, e.g. unique program or skill available at a particular facility; tertiary referral pathways. A maximum of two different facilities within same geographical area is recommended for split placements – explain why two sites are required to meet goals. As we may not be able to offer a placement to all applicants, please do not pre-arrange placement dates with your preferred facilitator/host site. Should your application be accepted your AHPEP placement coordinator will liaise with the host site.
Please note: Preferred facilitator/host site cannot be guaranteed.
If you wish to request a placement outside of Queensland Health, you must have a professional indemnity insurance policy in your name.
Do you have a professional indemnity insurance policy?
Yes
No
Comments:
Availability |
For the next six months please list all unsuitable and preferred dates for yourself and your service.
Please note: travel arrangements will not be amended once booked.
Professional support |
Do you have a professional support plan, as per the professional support guidelines? If yes, please describe. Have you discussed your application with your supervisor or mentor?
Placement proposal (this section onward will be sent to potential facilitator/host site)