STANDARD PATHWAY APPLICATION

TO DETERMINE ELIGIBILITY TO PROCEED WITH THE AMC EXAMINATIONS PROCESS, INCLUDING EICS VERIFICATION
SUMMARY OF PROCEDURES FOR APPLICANTS COMPLETING THE STANDARD PATHWAY APPLICATION
New applicants must submit the Standard Pathway Application, the assessment fee and all documentation before applying to schedule for an AMC MCQ examination. Refer to the AMC website (www.amc.org.au) for AMC CAT MCQ examination closing dates. 1. Assessment by the AMC of eligibility to sit for the AMC CAT MCQ examination is done on a first come, first served basis. Applicants will be able to proceed with the AMC examination with Conditional status provided a correctly certified copy of the primary qualification and completed and signed Primary Source Verification of Medical QualificationsAuthorisation for Release of Information Form have been submitted. The AMC will forward information on how to apply for an MCQ examination to eligible candidates. 2. Candidates assessed as eligible for the CAT MCQ examination: Candidates can apply and pay online for an MCQ authorisation by using the AMC website (www.amc.org.au), or by completing the MCQ Examination FormApplication for Authorisation to sit the CAT MCQ Examination and returning it to the AMC with payment. 3. Sit the CAT MCQ examination (either in Australia or in approved overseas venues). 4. When notified that you have passed the CAT MCQ examination, either lodge an online application for the clinical examination or complete and submit the Clinical Examination Application Form before the closing date of the selected series. The AMC notifies candidates of placement in a clinical examination series approximately 2 weeks after the relevant closing date. 5. Undertake the clinical examination (in Australia only) or workplace-based assessment. 6. Once you have been notified that you have passed the clinical examination, and when EICS verification has been confirmed, the AMC forwards your AMC Certificate to the relevant state office of the Medical Board of Australia for your collection and signature. 7. Apply to the Medical Board of Australia for registration.

If your application is assessed as incomplete, you will have to pay an incomplete application fee (AUD110) and submit the outstanding documentation within six months from the date of initial assessment. If you do not provide the required documentation, your application will lapse and your documentation will be destroyed. When you require a new assessment, you will keep your AMC candidate number. You will be required to submit a new application by completing the relevant paper-based application including the full application fee and ALL required documentation. Forms incorrectly completed will not be assessed and will be returned to candidates. Candidates will forfeit the application fee, and another full application fee will then be required with the correctly completed application form and all required documentation as listed in the checklist.
STATUTORY DECLARATIONS The AMC accepts the following as eligible to witness declarations (including the Standard Pathway Application and required assessment documentation):

IN AUSTRALIA
A Justice of the Peace Chief Magistrate Police Magistrate Resident Magistrate Special Magistrate. A person appointed under the Statutory Declarations Act 1959, as amended, or under a State Act to be a Commissioner for Declarations. A Notary Public.
A person appointed as a Commissioner for Declarations

OVERSEAS
Notary Public Commissioner of Oaths (South Africa, Sudan and Canada only) A person appointed to hold, or act in, the office in a country or place outside Australia in an Australian Embassy, High Commission, Legation or other post as: o o o o o Australian Consul-General, Consul or Vice-Consul. Australian Trade Commissioner or Consular Agent. Australian Ambassador or High Commissioner. Australian Minister, Head of Mission, Commissioner, Charg dAffaires or Counsellor. Australian Secretary or Attach.

u nder the Statutory Declarations Act 1911, or under that Act as amended, and holding office immediately before the commencement of the Statutory Declarations Act 1959.

Note: A Justice of the Peace registered outside Australia is NOT accepted by the AMC for witnessing documentation. It is important that the witness state in their wording that it is a certified true copy. A sample of acceptable wording is shown below.

The name and title of the witness and the date certified must also be included in the certification. Certification should be made on each page of the actual document. If the witness certifies the document on a separate page, it needs to be correctly notary bounded (no staples allowed). Application forms and documents that have not been witnessed as specified above are not legally recognised in Australia and will not be accepted.

Last updated December 2011

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STANDARD PATHWAY APPLICATION

TO DETERMINE ELIGIBILITY TO PROCEED WITH THE AMC EXAMINATIONS PROCESS, INCLUDING EICS VERIFICATION
Please read the information available on the AMC website (www.amc.org.au) and complete this form as instructed. Incomplete or incorrect applications will not be processed and an administration penalty fee of AUD110 will be applied. This Standard Pathway Application should be lodged with the assessment fee of AUD230 and specified supporting documents. The application will not be accepted if sent by email or facsimile. IDENTITY OF APPLICANT Family name (Surname): Given names: Date of birth
Day Month Year

CLIP OR GLUE 1 x PASSPORT SIZE PHOTOGRAPH HERE

DO NOT STAPLE OR TAPE

OFFICE USE ONLY FILE NUMBER

Male Female

Country of birth: DATE RECEIVED STAMP ADDRESS FOR CORRESPONDENCE Address: Code: ... Rcpt: State: Country: Postcode Amount: ... Prcd by: ...

CONTACT DETAILS Home phone: Mobile: Work phone: Facsimile:

Email address:

PRIMARY MEDICAL QUALIFICATION Country of training: Primary qualification: Year Year qualified: Year awarded:

Name on diploma: Medical school: Controlling university:

NAME CHANGE/VARIATION Is the name shown above the same as that shown on all the attached documents?

Yes

No (*read below)

* If NO, you are required to attach certified documentary evidence of your change of name. If you are submitting a statutory declaration, ensure that all variations are explained and state which name you wish to be known as for AMC purposes.

EVIDENCE OF IDENTITY All applicants applying through the Australian Medical Council (AMC) must satisfy the AMC of their identity. Applicants will need to provide proof of personal identity by way of submission of two (2) types of identification documentation. To view these requirements, visit the AMC website (www.amc.org.au). Please note that meeting the AMCs requirements for identification will not necessarily satisfy the Medical Board of Australias proof of identity requirements. Tick this box if you have submitted certified evidence of identification: Last updated December 2011 Page 2 of 6

DECLARATION BY APPLICANT Please print clearly and complete ALL fields I, of (Name) (Address) (Occupation)
DO SOLEMNY AND SINCERELY DECLARE THAT:

I am the person identified in the foregoing Standard Pathway Application I am the person who has signed below I have signed the Primary Source Verification Authorisation for Release of Information Form I have familiarised myself with the requirements and procedures of the AMC as set out in the relevant AMC publications or on the AMC website, as well as with the AMC Privacy Policy The statements made, and the information provided, in this application form and in the certified documents attached are true and complete.

Signature of person making the Declaration and Consent to Collect Information (applicants signature): Please sign inside the box to ensure the AMC is recording your full signature

Declared at
Name of city, town, suburb or locality

the
Date

day of
Month

year
Year

Before me*

Signature of person before whom the Declaration is made (Witness*)

Insert official title** of witness before whom the Declaration is made Insert the address of witness before whom the Declaration is made

Print name of witness in BLOCK LETTERS Contact number of witness.

* The person witnessing this Declaration must be the same person who certifies the documents of the applicant. If a different eligible witness is used to certify the supporting documentation, you must submit a statutory declaration explaining why a different witness was used and it must be witnessed by the new eligible witness. ** The title of the witness must be written (e.g. Notary Public, Justice of the Peace).

EICS VERIFICATION Since January 2006, all applicants for the AMC examination process (for non-specialist registration) and the AMC specialist college assessment pathway (for registration as a specialist) have required primary source verification of their medical qualifications through the International Credentials Services of the Educational Commission for Foreign Medical Graduates (ECFMG) in the United States of America. Applicants will continue to apply to the AMC for initial assessment. Subject to the vetting of their documents by the AMC, applicants will be able to continue with the AMC examination process. The documents will be forwarded to the ECFMG for verification through the original issuing university or institution. When confirmation of verification is received by the AMC, the candidature will be confirmed. The AMC will not be able to issue a final AMC Certificate after successful completion of the AMC examination process and until the verification has been confirmed. Candidates who have previously obtained confirmed verification of their primary medical qualification through the EICS will be required to provide the AMC with their EICS number and USMLE number (if available) and sign the Authorisation for Release of Information form to enable the AMC to obtain a copy of the verification report from the EICS. EICS NUMBER: USMLE NUMBER:

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METHOD OF PAYMENT I wish to have my primary medical qualification assessed AUD230 Payment can be made by: Bank cheque Money order (payable to Australian Medical Council) Credit card (see below)

PLEASE PRINT CLEARLY Credit card type: Credit card number: Cardholders signature: MasterCard Visa

Note: Recording the credit cardholders signature is taken as consent to process the payment

Card expiry date:

Month Year

Date:
Day Month Year

PAYMENT FOR ASSESSMENT IS REQUIRED EVEN IF EICS VERIFICATION HAS ALREADY BEEN CONFIRMED

PRIVACY Your privacy is respected by the AMC. Information collected by the AMC may be used for administering the AMC Examinations, and provided to the AMC examination sections as well as the Medical Board of Australia. The AMC privacy procedures are set out in a Privacy Policy statement which can be obtained from the AMC. If you have any privacy concerns or would like to verify information held about you, please contact the Privacy Officer, Australian Medical Council Limited, PO Box 4810, KINGSTON ACT 2604, Australia. Consent to collect information:

Signature:
Day Month Year

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EICS VERIFICATION OF MEDICAL QUALIFICATIONS

Authorisation for Release of Information Form
I hereby authorise: 1. The Australian Medical Council Limited (AMC) to submit my personal (identifying) information and my candidate information (documents in support of my medical credentials) to the Educational Commission for Foreign Medical Graduates (ECFMG) for the purpose of verification and/or source verification in respect of my application ECFMG to retain such information in ECFMGs database for the purposes of: a) addressing any further requests from the AMC for verification and/or source verification in respect of my application b) responding to any request sent to ECFMG from an authority other than the AMC, as authorised by me, or directly from me, to verify and/or source verify my credentials c) internally accessing those portions of the data which are not personal information in order to verify credentials of other persons from time to time.

2.

I request and authorise every person, institution, professional licensing board of any state or country in which I hold or may have held a licence to practise my profession, hospital, clinic, government agency (local, state, federal or foreign), law enforcement agency or other third parties and organisations, and their representatives, to release information, records, transcripts and other documents, concerning my professional qualifications and competence, ethics, character and other information pertaining to me to ECFMG. I further request and authorise that the requested information, documents and records be sent directly to: Educational Commission for Foreign Medical Graduates 3624 Market Street Philadelphia, PA 19104, U.S.A. IMMUNITY AND RELEASE I hereby extend absolute immunity to, and release, discharge and hold harmless from any and all liability: a) b) c) ECFMG and AMC and their respective agents, representatives, directors and officers other licensing boards, government agencies, institutions, hospitals and clinics providing information pursuant to this authorisation, and their representatives, directors and officers any third parties and organisations for any acts, communications, reports, records, transcripts, statements, documents, recommendations or disclosures involving me, made in good faith and without malice, requested or received by ECFMG or AMC or any other third party.

By my signature below, I acknowledge that information, documents and records required to be furnished by another organisation, educational institution, hospital, individual or any person or groups of persons must be sent directly by such persons to ECFMG. I understand that ECFMG will not accept such information, records or documents forwarded by me. A photocopy or facsimile of this authorisation form shall be as valid as the original and valid from the date signed.

Date of Signature

Day

Month

Year

Signature Ensure this signature is similar to the signature on the Application Declaration.
Please sign inside the box to ensure that the AMC is recording your full signature

Securely glue in this square a current frontview passport-sized colour photograph of yourself in the block belowdo NOT tape or staple the photo. Please clearly print your full names on the back of this photo.

PLEASE PRINT Family name / Surname First name

The passport-sized photographs MUST be: in colour good quality no older than 12 months no smaller than 35 mm x 45 mm no larger than 40 mm x50 mm no ink or marks on the edges not too dark not too light Do NOT staple or tape

Middle initial, suffix (e.g. Jr)

Date of birth
Please ensure your date of birth is written in full (e.g 23 January 1970)

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Checklist for Standard Pathway Application

The following checklist should help you collate the required documents. If you do not provide these documents or if the documents you provide are not clearly legible or in full, processing of your application will be delayed. For details about the required documents, see the information available on the AMC website (www.amc.org.au).

Have you answered all questions on the Standard Pathway Application? Have you attached to the Standard Pathway Application 2 current (no older than 12 months) colour passport-sized photographs with your name printed clearly on the back? One is to be attached to the Standard Pathway Application and one to the Primary Source Verification of Medical QualificationsAuthorisation for Release of Information Form. Have you completed in full the Primary Source Verification of Medical QualificationsAuthorisation for Release of Information Form and attached to it a current (no older than 12 months) colour passport-sized photograph? Have you included a certified copy of your final hang on the wall primary medical qualification? Have you included a certified copy of an English translation of your primary medical qualification if it is in a language other than English? The translation must have been done by an authorised translation service. The AMC translation policy is available at http://www.amc.org.au/index.php/ass/apps/trans. Have you submitted certified evidence of your identity according to the AMCs proof of identity requirements available on the AMC website (www.amc.org.au)? Has your documentation been certified correctly, dated and signed (with name and title printed) by the same eligible witness who witnessed your Standard Pathway Application? A list of eligible witnesses can be found on the front page of this application and on the AMC website (www.amc.org.au). If a different eligible witness has certified your documentation or witnessed your application, you must correctly complete a statutory declaration to explain why a different witness was used. Have you provided a statutory declaration or change of name documentation for any name variations in your application or any of the supporting documentation you are submitting? Have you included a cheque or money order or your credit card details for payment of the assessment fee? Have you attached to any document that is in a language other than English an English translation conducted by an authorised translation service or a professional translator and are the details of that translation service or translator on the translated document? Have you provided proof of English language proficiency? The AMC encourages candidates to demonstrate their English language proficiency before undertaking the AMC examinations. However, it is not an examination requirement. Applicants will be required to demonstrate valid evidence of English language proficiency when presenting to the Medical Board of Australia seeking medical registration.

Assessment will not begin until payment of the assessment fee has been processed and the AMC has received the Standard Pathway Application with assessment documentation and the Primary Source Verification of Medical Qualifications Authorisation for Release of Information Form. If any of these documents are not included or if they are incorrectly certified, your assessment will not be complete and will cause a delay in the assessment process. The Standard Pathway Application will NOT be accepted if sent by email or facsimile. IMPORTANT NOTE If you intend to schedule for the AMC CAT MCQ Examination, the documentation listed above must be received at the AMC before the relevant examination closing date. The examination dates and closing dates are listed on the AMC website: www.amc.org.au.

SEND YOUR COMPLETED APPLICATION FORM(S), CERTIFIED DOCUMENTS AND PAYMENT TO: For courier, registered or insured mail: Australian Medical Council, Level 3, 11 Lancaster Place, Majura Park ACT 2609 For standard national mail: Australian Medical Council, PO Box 4810, Kingston ACT 2604 For international mail: Australian Medical Council, PO Box 4810, Kingston ACT 2604, AUSTRALIA

Last updated December 2011

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