Annual Continuing Professional Development Exemption Form 2017/18 Please view instructions and guidance notes overleaf Write clearly using CAPITAL LETTERS and tick boxes where applicable Family Name: First Name(s): Membership ID: Country: Section 1 please select one of the below options. – Before selecting your option please read the instructions and guidelines overleaf. Option A FULL EXEMPTION – I have not or will not be able to meet my CPD requirement for 2017/18 however, due to the circumstances outlined and evidence provided, I believe that I am eligible for a Full Exemption (20 hours) for 2017/18. Option B PART EXEMPTION – I have met or will meet at 10 hours of CPD requirement (Time-Valued and/or Independent) for 2017/18, however due to the circumstances outlined below and evidence provided, I believe that I am eligible for a Part Exemption (10 hours) for 2017/18. Section 2 All information provided will be treated confidentially and with upmost sensitivity. Provide the reason(s) that you are applying for a full (20 hour) or part (10 hour) exemption: Provide details of the documentation enclosed to support your application: Section 3 I confirm that the information I have given in this form is true to the best of my knowledge, and I understand that I may be selected at random to participate in an annual CPD Audit. If selected I will provide evidence of my CPD activity. I understand that failure to do so, or submission of a false declaration is a breach of the Code of Professional Practice for teachers registered with the Royal Academy of Dance and I may be subject to sanctions. If you are submitting this form via please tick here and type your name below as a substitute for your signature. Signature: Date: Send to Email: Please mark the subject of your email Exemption Form” and include your membership number “CPD Post: Attention of Bethany Lifeso (CPD), Royal Academy of Dance Canada, 601-1210 Sheppard Ave East, Toronto, ON, M2K 1E3 Fax: 416-489-3222 Internal Use Only Staff Initials: Date Received: Outcome: Date Processed: Declaration and Exemption Instructions and Guidance
Annual Continuing Professional Development Exemption Form 2017/18 Please view instructions and guidance notes overleaf Write clearly using CAPITAL LETTERS and tick boxes where applicable Family Name: First Name(s): Membership ID: Country: Section 1 – please select one of the below options. Before selecting your option please read the instructions and guidelines overleaf. Option A – FULL EXEMPTION I have not or will not be able to meet my CPD requirement for 2017/18 however, due to the circumstances outlined and evidence provided, I believe that I am eligible for a Full Exemption (20 hours) for 2017/18. Option B – PART EXEMPTION I have met or will meet at 10 hours of CPD requirement (Time-Valued and/or Independent) for 2017/18, however due to the circumstances outlined below and evidence provided, I believe that I am eligible for a Part Exemption (10 hours) for 2017/18. Section 2 All information provided will be treated confidentially and with upmost sensitivity. Provide the reason(s) that you are applying for a full (20 hour) or part (10 hour) exemption: Provide details of the documentation enclosed to support your application: Section 3 I confirm that the information I have given in this form is true to the best of my knowledge, and I understand that I may be selected at random to participate in an annual CPD Audit. If selected I will provide evidence of my CPD activity. I understand that failure to do so, or submission of a false declaration is a breach of the Code of Professional Practice for teachers registered with the Royal Academy of Dance and I may be subject to sanctions. If you are submitting this form via please tick here and type your name below as a substitute for your signature. Signature: Date: Send to Email: Please mark the subject of your email “CPD Exemption Form” and include your membership number Post: Attention of Bethany Lifeso (CPD), Royal Academy of Dance Canada, 601-1210 Sheppard Ave East, Toronto, ON, M2K 1E3 Fax: 416-489-3222 Internal Use Only Staff Initials: Date Received: Outcome: Date Processed: Declaration and Exemption Instructions and Guidance
201718-cpd-exemption-form-canada.docx