Selection Enrolment Form

Trainee Enrolment Form
Congratulations on your successful application for Selection into FACEM Training!

This form will allow you to submit an application to either;
- enrol into the FACEM Training Program, or
- defer commencement of training.
Applications to enrol or defer must be submitted by the date specified in your invitation to enrol. Applications received after this date, or applications that are incomplete or missing items, will not be considered and the offer to enrol into the FACEM Training Program will be forfeited.

Prior to enrolling, applicants are advised to read and understand the following:
- Trainee Enrolment Policy
- FACEM Training Program Regulation G
- ACEM Curriculum Framework
For assistance and enquiries, please contact the Training Services team by email at training@acem.org.au, or by phone on +61 (0)3 9320 0404.

Trainee Enrolment Form

Personal Details
Full Name*

TitleFirst NameMiddle NameLast Name
Gender*
Date of birth (DD/MM/YYYY)*
Email*
example@example.com
Application No.*
You will find this on your invitation to enrol
All applicants are required to have General Registration with either the Australian Health Practitioner Regulation Agency (AHPRA) or the Medical Council of New Zealand (MCNZ).

Please provide your registration number for the relevant regulatory authority.
AHPRA/MCNZ number*
Are you aware of any complaint to or investigation being undertaken by any medical registration authority, which may affect your medical registration?*

YesNo
Please provide details *
Please select one option from the following:*

I wish to apply for enrolment into the FACEM Training ProgramI wish to apply to defer commencement of training

Trainee Enrolment Form

Defer Commencement of Training
Applicants who are invited to enrol in the FACEM Training Program may apply to defer commencement of training by 12 calendar months.

A single deferral per application is permitted. If enrolment is not completed by the due date after the deferral period, the invitation to enrol will be forfeited and a new application for Selection into FACEM Training will need to be submitted. In these circumstances, the original application will constitute one unsuccessful application.

In exceptional circumstances an applicant may seek to extend deferral of commencemnt of training for a further 12-month period. Any such application must be made via the Exceptional Circumstances and Special Consideration Policy and must be received by the College prior to the expiry of the original deferral period.
Please attach a letter addressing your reasons for deferral, including any pertinent information which may assist the College when considering your application.*

Attach Files

Cancelof
Declarations*

I declare that this information provided in this application is accurate and complete the the best of my knowledge.I understand that I will be notified by the College of the outcome of my application once a decision has been made.I understand that if my application for deferral is successful, my invitation to enrol will be deferred for the entire training year, and I will be notified when enrolments are open for the following year.I understand that if my application for deferral is successful, I will be required to pay all applicable fees at the time of enrolment the following year.I understand that if my application for deferral is successful, and I subsequently fail to enrol by the specified deadline, I will forfeit the invitation to enrol and this will count as one unsuccessful application for Selection into FACEM Training.

Trainee Enrolment Form

Defer Commencement of Training
Upon clicking 'Submit', your details will be saved and your application to defer commencement of training will be submitted.

No changes can be made to your application after submission. Applications that are incomplete or missing items will not be considered.

Trainee Enrolment Form

Contact Information
Telephone
Mobile*
Address*

Street Address 1

Street Address 2

SuburbState

Postal Code
Postal Address (if different from above)

Street Address 1

Street Address 2

SuburbState / Province

Postal Code

Trainee Enrolment Form

Placement Details
If known, please provide full details of your first placement for the 2026 training year.

Please note that your placement will only be considered as time towards your FACEM training requirements from the start of the training year. Any training completed in a placement before this date will not be counted.

Should you be undertaking a placement in an accredited Paediatric Emergency Department, this is not eligible to meet Training Stage 1 requirements. Please contact training@acem.org.au should you have any questions.
Start date

DayMonthYear
End date

DayMonthYear
Site
Name of hospital
Discipline
Specify the discipline of this placement
Supervisor
Name of supervisor
Full time / Part time

Full time0.5 FTE0.75 FTEOther

Trainee Enrolment Form

Recognition of Prior Learning
Do you intend to apply for Recognition of Prior Learning or Credit Transfer?*

YesNo
Have you completed any of ACEM's publicly available online modules (ultrasound, core values, etc.)?*

YesNo
Please review the Policy on Recognition of Prior Learning and Credit Transfer, which sets out the principles and processes by which applications will be assessed.

Please contact the Training Services team to request a copy of the application form, should you wish to apply.

Applications must be received within the first six (6) months of commencement in the training program. It's also important to understand that any training you wish to have recognised must have been completed within the last five (5) years.

Applications should be submitted by email to training@acem.org.au.

Trainee Enrolment Form

Trainee Agreement - Part 2: Obligations
I acknowledge that as a trainee, I have the following obligations:*

2.1 To abide by the professional standards of all registered medical practitioners as outlined in the professional codes of conduct of the Medical Board of Australia or the Medical Council of New Zealand as applicable and from time to time updated, as well as those of ACEM.2.2 Except where otherwise permitted by the College, to hold general registration with the Medical Board of Australia or registration in the general scope with the Medical Council of New Zealand as applicable at all times while undertaking the FACEM Training Program.2.3 To notify the College within the timeframe prescribed in the regulation if my medical registration with the Medical Board of Australia or Medical Council of New Zealand as applicable expires or if, for any reason, my medical registration is under investigation, withdrawn, suspended or conditions are imposed.2.4 To regularly visit the training portal and ensure the College has an accurate and current record of my contact and other details, and to maintain a working email account capable of receiving College correspondence and other communications from the College.2.5 To be aware of and observe all College regulations, policies, procedures and other processes relevant to me as a trainee enrolled in and undertaking the FACEM Training Program.2.6 To meet regularly with my DEMT and to participate fully in all College assessment and review processes, including in the development and implementation of a Learning Plan where beneficial or required.2.7 To undertake training in a range of settings and locations as required by the College in order to complete the requirements and achieve the outcomes of the FACEM Training Program.2.8 If I have concerns regarding my training, it is my responsibility to initiate the process through the College to have these concerns addressed.

Trainee Enrolment Form

Trainee Agreement - ACEM Declaration
ACEM Declaration

ACEM agrees to provide support to its representatives, including DEMTs, Local WBA Coordinators, non-ED supervisors of training, WBA assessors and education officers, to provide trainees with appropriate resources and support in the following areas:

4.1 Achieving completion of all training periods, and assessment and other requirements of the FACEM Training Program.

4.2 Resources to assist trainees in achieving the learning outcomes of the FACEM Training Program.

4.3 The provision of supervision appropriate to the trainee’s level of training and having regard to the clinical setting, and regular review of performance during a placement for the purposes of support, feedback and assessment.

4.4 Fostering a training environment that is free from discrimination, bullying and harassment in the workplace.
ACEM Obligations

ACEM undertakes:

5.1 Through its accreditation processes, to strive to ensure training occurs in suitable and appropriately resourced and supported departments and placements.

5.2 To communicate training, assessment and other College decisions in a timely manner having regard to the entirety of the circumstances.

5.3 To give adequate notice of changes in the requirements of the FACEM Training Program, including the introduction of new requirements, to which existing trainees become subject.
Declarations*

I accept the rights and responsibilities of my position as detailed in this agreement.I declare that this information provided in this application is accurate and complete tothe best of my knowledge

Trainee Enrolment Form

Payment Details
You will be invoiced for payment of the Entrance Registration Fee and the Annual Training Fee within 2 weeks of receiving your ACEM Member Portal Login details. Please refer to your Invitiation to enrol for additional information regarding this.
- Entrance Registration Fee: AUD $864.00
- Annual Training Fee: AUD $2,267.00
Total payable: AUD $3,131.00

Invoices will be sent to the email address provided on your application.

You must make payment by the due date stipulated in your invitation to enrol to complete your enrolment and be considered a FACEM Training Program trainee.
Upon clicking 'Submit', your details will be saved and your application to enrol into the FACEM Training Program will be submitted.

No changes can be made to your application after submission. Applications that are incomplete or missing items will not be considered.
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