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Personal Data CETC Certification Form 0
EUROPEAN TRANSPLANT COORDINATOR CERTIFICATION - PERSONAL DATA

Please fill in:

Personal Data Information :
(Print your name as you wish it to appear on your certificate of competency)
Last Name:
 First Name:  
Bussines Address:
 Country:  
Postal Code:
City:  
Phone Number: Fax:  
Email:      
         
Highest Level of education (check one) :      
Diploma nursing

Technician's degree

 
Associate's degree

Bachelor's degree

 
Master's degree

Medical Doctor 

 
Other    

Professional license or registration: (check one)

   
Registered Nurse

Nurse Practitioner

 
Medical Technologist
Paramedic  
Social Worker
Physician  
Other    
Years of Transplant Coordinator experience :    

Primary place of employment (check one)

   
Private or government / military Transplant Hospital
 
University Transplant Hospital
Non-transplant Hospital  
Local or Regional Sharing Office
Independent OPO  
Supranational Sharing Office

National Sharing Office

 

Other  

     
         
I certify that I have read all sections of this application and believe that I comply with all admission requisits for the  ETCO European Transplant Coordinator Certification. The information I have submitted in this application is complete and correct to the best of my knowledge and belief.
  
I understand that if the information I have submitted is found to be incomplete or inaccurate, my application may be rejected or my examination results may be delayed, not released, or invalidated by the ETCO-CCB. I also understand that the ETCO-CCB may confirm my eligibility for this examination by verifying my academic/professional credentials and/or by contacting the employers listed.
         
Signature: Date :

 
         

Mail this application with all the required documents or sen it to:
(fill the documents check-list included below)

ETCO – Credentialing and Certification Board Assistance
IL3 – University of Barcelona
c/ Ciutat de Granada 131
08018, Barcelona
Spain
Emai: secretariat@etco.org

 
    Maximum transfer limit 800 Kb  
Certificate of present job as TC
Certificate of Experience as a TC

Diploma(s) of training as a TC
A copy of your Valid Health License
Your CV
 
 
 
 
 
 
Print
 
 
Executive Office Letter of the President Structure of Etco Committees Organs & Tissues
National Key Members Annual Meeting of ETCO Certification Future Congress Etco Board
Recommended Bibliography Donation Bibliography Transplantation Guidelines Future Events Congress in Prague 2007
Transplant Organizations Transplant Centers Europe Journals Transplantation Donation Forums Organ Procuremenet
Irodat 2005 Statistics Subscription Information Membership Application Sponsors Etco bylaws

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