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APPLICATION FORM REGISTRAR EXTENSION AWARD Name Region Training level Email Mobile Note: You must be at PRRT3/GPT3 level or above to apply. Please ck at least two of the below criteria to confirm your eligibility, then complete the applicaon form below with your submission up to 1000 words. Above expected in more than half of the Inial Assessment acvies Above expected in more than half of the Further Assessment acvies Top band in RACGP AKT Top band in RACGP KFP Top band in RACGP OSCE Nominated as future candidate as REST Instructor at compleon of REST course with MCCC Performance band 1 for 80% or above in both paent and colleague feedback in MSF and completed the acvity successfully Achieve 4 ranking in Overall Impression in PC Stamps results in at least 6 of the 8 staons Three or more ECTVs assessed as ‘Above expected’ overall Three or more supervisor reports assessed as ‘Above expected’
