CETC - Certification of present job as a Transplant Coordinator Form 2

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CETC- Certification of present job as a Transplant Coordinator Form 2

EUROPEAN TRANSPLANT COORDINATOR CERTIFICATION - Certification of present job as TC

Certification of Present Job as Transplant Coordinator :

Email:
Medical Director:		(and name of Hospital/Organization)
CERTIFY THAT :
Last Name:		(Family Name)
First Name:		(CETC Applicant name)

Employed From:

/ / (dd/mm/yy)

To:

/ / (dd/mm/yy)


NOTE: If the applicant has previously worked in any other hospital/organization as a Transplant Coordinator, the following information should be filled:
Hospital/organization:
Previous Job/Title:
Employed From:	/ / (dd/mm/yy)	To:	/ / (dd/mm/yy)
Hospital/organization:
Previous Job/Title:
Employed From:	/ / (dd/mm/yy)	To:	/ / (dd/mm/yy)


IS WORKING AS A TRANSPLANT COORDINATOR AT THE MOMENT:
Name of (Hospital/Organization) Director

Signature:
(Stamp of your Organization)

______________________________

Date:

__________________

Please mail this application to:

Board for ETCO - European Transplant Coordinator Certification
Dirección Académica - Les Heures (Universidad de Barcelona)
Palau de les Heures, Llars Mundet
Passeig de la Vall d'Hebron, 171
08035 Barcelona
Spain

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