Certificate in Electrocardiography
THE SOCIETY FOR CARDIOLOGICAL SCIENCE AND TECHNOLOGY Application to enter the Certificate in Electrocardiography Members of SCST £120 with practical £80 exam only Non-members £150 with practical £130 exam only th The Examination will be held on March 7 2015 The closing date for entry is 9th January 2015, applications received after this date will NOT be accepted. IMPORTANT This application form is valid only for the date shown above and will NOT be accepted if it is altered to any other date. (Please print clearly using BLOCK CAPITALS and fill in ALL sections of the form) SURNAME ............................................................................. ( Mr / Mrs / Miss / Ms ) JOB TITLE …...........….……… FIRST NAMES ....................................................................................................................................................................... MAIDEN NAME …………………………………………………………………..Date Of Birth………………………………… ADDRESS (To which ALL correspondence will be sent, preferably not your hospital) ......................................................................................................................................................................................... ................…….................................................……................................................. POST CODE ……............................ Telephone Number ........................………...……… SCST Membership number …………………………. HOSPITAL ................................................................................................................................................................ .. Department ……………………………………………….…Hospital Telephone Number …………………………………….. Email Address……………………………………………………………………………………………………..……………………….. Please tick as appropriate:- Receipt required - BIRMINGHAM ONLY BOURNEMOUTH ONLY PLEASE NOTE: to be awarded the Certificate in Electrocardiography you MUST successfully complete both the written examination AND the practical assessment If you are applying for the Written Examination only:- Please confirm you have passed the practical element within the last 5 years by entering the year in the relevant exam box. Award in Electrocardiography Certificate in Electrocardiography Undergraduate Assessment Part I The Examination centre will be in Birmingham. Candidate details will be forwarded 28 days prior to the exam date – this will be sent to the email you have provided. It is the responsibility of the candidate to notify the administrator of any special requirements. Dyslexic students must provide evidence at least 28 days prior to the exam date. Cancellations or deferrals must be made 28 days in advance – Any deferrals and cancellations prior to 28 days will incur a £10 admin fee will. Any cancellations within 28 days will forfeit the fee. Cheques should be made payable to SCST Please send the completed form and payment to: SCST, Executive Business Support (EBS), City Wharf, Davidson Road, Lichfield, Staffordshire WS14 9DZ The Society for Cardiological Science and Technology (SCST) is the professional body for Cardiac Physiologists and Cardiographers. SCST seeks to promote good professional practice and standards throughout Cardiology. An individual is entitled to apply for membership of SCST if they are actively working in the field of cardiology, either as a Cardiac Physiologist, an Associate Practitioner in Cardiology or as a Cardiographer. Membership forms to join the Society as a pre-enrolled member are available on the SCST website. There are two Electrocardiography examinations available through SCST:The Certificate in Electrocardiography( Written and practical assessment) is suitable for Cardiographers, Senior Cardiographers, ATOs (Assistant Technical Officers) in Cardiology and Senior ATOs. See syllabus on SCST website. The SCST Award in Practical Electrocardiography (recording only) is appropriate for any healthcare professional who is involved in recording 12-lead ECG's. [ Official use only below this line ] Bank _____________________ Cheque/Invoice No: _________________ Amount ___ ___ ______ _ Date_________________
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