CPD Home Application Form


CPD Home Application Form

Please ensure that you have answered all the required fields and uploaded all the required documents in order for your application to be submitted successfully.

Applicant's Personal Details

Part 1/2

Include prefix

Section A Medical Practitioner Relevance

How to proceed

If you answered "No" to any of the above questions, please proceed to section B below.

If you answered "Yes" to question 6 and you are intending to return to practice, please continue with this application form. Otherwise...

If you answered "Yes" to any of the above questions, please be advised it is not mandatory for you to meet Aphra/MBA Registration standard: Continuing professional development (CPD) and therefore it is not mandatory for you to join a CPD Home. However, if you wish to proceed under an 'optional' basis, please tick the declaration below before you proceed to provide further information in this application form.

  • I fulfil the criteria under one or more of the above questions within Section A of this form.
  • I acknowledge the fact that it is not mandatory requirement for me to belong to a CPD Home while this criteria/ion is applicable to me.
  • I accept it is not a requirement for the CPCA CPD Home to review my CPD plan/s and activities for compliance purposes and as a result, I may not receive any forewarning of CPD compliance shortfalls.
  • I understand that it is my responsibility to inform the administrator of the CPCA CPD Home if and when my current circumstances change and it becomes a mandatory requirement for me to belong to a CPD Home where my CPD plan/s and CPD activities are subject to compliance checks.
In addition to this check box below, by submission of this fully completed application, the applicant is deemed to have formally made this declaration.

Additional Personal Details

Part 2/2

Section B Scope of Practice (SoP)

If you have a mandatory requirement to meet the CPD Program of an accredited medical specialist college please indicate this above.

Section C CPD Home Membership History

New/First Year of CPD & Record Keeping: If you have not used another CPD Management System provided by the CPCA or another entity, please indicate below.(Required)
Returning from Short/long Term Absence(Required)
Further information will be collected via Section D
CPCA member transferring from CPCA CPD Wizard?(Required)
Transferring from an external CPD Home: If you are transferring from another provider of a CPD Management System or CPD Home, please indicate below.(Required)
Requirement to Import CPD Records(Required)
Please indicate above if you have current year CPD records you wish to import. Instructions will be issued to you on how you can import your records.

Section D Recency of Practice

Recency of Practice

You are re-entering practice after a recent absence?
You have recently or a planning on a change to your 'scope of practice'?

If you answer "FALSE" please proceed to section E.
Recency of Practice(Required)
Please tick the relevant boxes below:

Non-practising registration or not registered and returning to practice

(includes international medical graduates)
International Med. Grad.

Less than 2 years clinical experience as a reg. med. practitioner

A registered medical practitioner who has not been registered for more than 12 months, or has not practised for more than 12 months.
<2 yr clinical/<12 mths non reg/practice

2+ years clinical experience as a reg. med. practitioner

2+ yrs clinical/<12 mths non reg/practice
2+ yr Clinical/12-36 mths non reg/practice
2+ yr clinical/36+ mths non reg/practice

Recent Change to Scope of Practice (SoP)

If you have undergone a change in your field or scope of practice, you may be required to undergo additional training to ensure you are competent in the new field or scope of practice.
Have you undergone a change to your scope of practice?
Using the below options, how would you best explain the outcome to the change of field or scope of practice? If you have undergone more than one change and cannot account for all the changes within the questions below, please email additional information to cpca@cpca.net.au or use the below "file upload" facility to provide additional documentation. Thank you.
Narrowing scope of practice?
Reasonable extension of scope of practice?
Unrelated field or scope of practice?

File Upload Facility

Please feel free to upload any additional supporting documentation
Drop files here or
Accepted file types: jpg, gif, png, pdf, Max. file size: 10 MB.
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