Application for Entry Exam

*First Name

*Surname

*Email

*Street Address

*Postcode

*Suburb

*Country

Telephone

Mobile

Do you identify as being of indigenous background?

No

Aboriginal and/or Torres Strait Islander

Maori

Rather not say

*Proof of permanent residency or citizenship of Australia or New Zealand

*Medical Registration

Please upload evidence of your Medical Registration to practice in Australia or New Zealand

*Medical Degree

Please upload a copy of your MBBS or equivalent

*Have you previously sat the ACSEP Entrance Exam?

yes

no

RPL

RACP

RACS

ACEM

Date equivalent Entrance Exam was obtained

Evidence of RPL

Please upload supporting documents as proof of RPL

If yes, in what year/s did you previously sit the exam?

Did you pass any section of the exam?

Part A (Anatomy)

Part B (Physiology)

Exercise Physiology Only

Please tick

*Applicant’s Declaration

Yes/Accept

Personal Contact Details