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CEP Return

CEP Return 2011

	Please make one entry for each competency you wish to claim.
.
Member number *
Surname *
First name *
Work phone
Mobile
Email *
Year end *
Practice *
Competency *
	Are the Hours OK?
	Are the Basic Hours OK?
	Are the BHA Hours OK?
	Are the BDA Hours OK?
	Are the Extended Hours OK?
	Are the EAD Extended Hours OK?
	Are the EAR Hours OK?
	Are the ECC Hours OK?
	Are the ECA Hours OK?
	Are the EHA Hours OK?
	Are the EPA Hours OK?
	Are the ETA Hours OK?
	Are the Restricted Hours OK?
	Are the RCS Hours OK?
	Are the RIS Hours OK?
	Are the Specialist Hours OK?
	Are the SDEC Hours OK?
	Are the SCA Hours OK?
	Are the SGP Hours OK?
	Are the SPS Hours OK?
	Are the SRS Hours OK?
Area
Mandatory Congress		ACAud AAA EUHA ASA - MAX 25. No other conference may be claimed as a mandatory conference. If not yet attended, state name and year of conference but do not claim points until attended
Approved Activities		Approved Activities - MAX 20 ACAud CEP Days and Activities with an ACAud Approved Number on the Certificate
Supervision to a Member		Supervision - MAX 15 The Supervisor may claim points for supervision of a Member one point per hour
Supervision to a Member		Supervision - MAX 15 The Supervisor may claim points for supervision of a Member one point per hour
Examination of a Member - MAX 15		An Examiner may claim points for examining a member
Tutoring or Training of a Member		Tutoring or Training of a Member - MAX 15 Tutoring or Training of another member
Presentation of a Paper		Presentation of a Paper/Workshop - MAX 5 This may include seminars, workshops, training to a group, etc
Formal Study		Formal Study - MAX 20 Formal Study in an approved field. Students may not claim Diploma, Associates may not claim supervision and Ordinary & Fellow Members may not claim clinical hours
Formal Research		Formal Research - MAX 20 Formal Approved Research in an appropriate Field
Total Points Claimed *		Enter in no more than section maximum
.
Formal Representation of ACAud		Formal Representation of ACAud - MAX 10 Formal Representation of ACAud as a member of the Executive, Education, Membership, Conference Committees or External Forums/Meetings
Formal Representation of ACAud		Formal Representation of ACAud - MAX 10 Formal Representation of ACAud as a member of the Executive, Education, Membership, Conference Committees or External Forums/Meetings
Independent Activities		Independent Activities - MAX 10 Additional Activities in the science of Audiology - Conferences,Seminars & Workshops w/o ACAud Approval,In-House Training
Reading & Multi Media Studies		Reading & Multi Media Studies - MAX 10 Reading, Internet Study or Reasearch in an appropriate area (This may include day to day activities where a clinician may need further information on a specific topic or appliance.
Rural Member Levy		Rural Member Levy - (Only Members with written Annual Approval may claim here) Rural Members may claim an additional 20% for ONLY those items to which a Rural Member must travel (eg conference - most attendees would need to travel, reading - rural member need not travel, CEP Day - most members would not need to travel so rural member may claim under guidelines, etc. Rural Members may increase Independent Activities and Reading and Multi Media Studies to a COMBINED total of 25.