Application Form for Reinstatement of Fellowship Status

Group Photo Of Professional Colleagues Working Together In Clinical Analysis Laboratory

Requirements for Reinstatement as a Fellow of the Canadian Academy of Clinical Biochemistry

All applicants for reinstatement of Fellowship must have been a full member of CSCC and Fellow of CACB in good standing for the 3 years preceding suspension and able to document required continuing education credits to meet the Professional Development rules and guidelines in effect at the time of reinstatement application.

All applicants must meet one of the following requirements:

Possess Certification in Clinical Chemistry/Biochemistry as issued by the Canadian Academy of Clinical Biochemistry (CACB)/Canadian Society of Clinical Chemists (CSCC).
Possess a Specialist Certificate in Clinical Biochemistry issued by the Ordre des Chemistes du Quebec (OCQ) since 2000.
Possess Fellowship in Medical Biochemistry, be a member of the Royal College of Physicians and Surgeons of Canada in good standing, and work in the field of Medical Biochemistry.
Must have successfully completed a two (or more) year accredited Clinical Chemistry/Biochemistry training program and be a doctoral certified member or Fellow of an approved Foreign Academy of Clinical Chemistry/Biochemistry¹ and be successful in the CACB Oral examination.

¹ Currently acceptable designations are Diplomate of the American Board of Clinical Chemistry (DABCC) or Fellowship of the Royal College of Pathologists in Clinical Pathology (FRCPath from US, UK or Australia).

Instructions on Applying for Reinstatement of Fellowship Status

Complete the application form.
All applicants must submit a current curriculum vitae and documentation of continuing education for the previous 5 years.
Applicants applying under categories 2 – 4 must also submit diplomas, certificates, continuing education credits and degrees relating to Clinical Chemistry/Biochemistry.
The application must be signed by the applicant. Signature on the application form will be taken as affirmation that the credentials listed are correct.
Validation Fees: This once-only fee must accompany the application: CDN $200 + the provincial tax where you reside (see below):

Province	Provincial tax rate
AB, BC, SK, MB	5%	GST
ON	13%	HST
NS	14%	HST
NB, NL, PE	15%	HST
QC	14.975%	GST/QST
Outside Canada	0%	HST

Note: Only the Board of the Academy can award the reinstatement of Fellowship status.

If you have any queries, please contact CSCC Head Office: info@cscc.ca

Application Form for Reinstatement of Fellowship Status

Application For Reinstatement of Fellowship Status In The Canadian Academy Of Clinical Biochemistry

Subtotal

$ 0.00 CAD

(Tax calculated below - if applicable)

Name(Required)

First Last Initial

Full member of the Canadian Society of Clinical Chemists since:

Certification(Required)

Yes

Certification Date(Required)

Administered By(Required)

CACB

OCQ

Other

Other: Name and corresponding address(Required)

CACB Oral Examination Completed(Required)

Yes

CACB Oral Examination Date(Required)

FELLOW OF CACB

Effective Date:

Applicants having successfully completed the CACB oral examination should proceed to the SIGNATURES section.

All other applicants must complete all remaining sections.

NOTE: Selecting "NO" on the question "CACB Oral Examination Taken" (above) reveals the remaining sections.

UNIVERSITY DEGREES: Please attach photocopies of diplomas and certification documentation.(Required)

Year

Discipline

University

UNIVERSITY DEGREES DOCUMENTATION(Required)

Drop files here or

Max. file size: 60 MB.

ACADEMIC APPOINTMENTS:(Required)

Position

University

Effective date

Number of years of professional experience in clinical biochemistry(Required)

Full member of the Canadian Society of Clinical Chemists since(Required)

POSITIONS HELD SINCE COMPLETION OF ACADEMIC TRAINING:(Required)

Position

Institution

Inclusive dates

EMPLOYMENT HISTORY (Previous 5 years):(Required)

Position Title

Institution

Inclusive Dates

ACADEMIC POSITIONS:(Required)

Position Title

Institution

Inclusive Dates

COMMITTEE AND OTHER PROFESSIONAL ACTIVITIES:(Required)

Position Title

Institution

Inclusive Dates

CONTINUING EDUCATION ACTIVITIES (PREVIOUS 5 YEARS)

Attach summary documentation of participation including title of the education event, location, dates, hours of attendance and certificate of participation.

Untitled

SUMMARY DOCUMENTATION(Required)

Drop files here or

Max. file size: 60 MB.

LIST OF TWO PROFESSIONAL REFERENCES:

The Credentials Committee of the Academy requires contact information for two (2) letters of reference to support the reinstatement application.

POSITIONS HELD SINCE COMPLETION OF ACADEMIC TRAINING:(Required)

Position

Full address

Telephone number

SIGNATURES:

I attest that the above statements are true, and I hereby apply for fellowship in the Canadian Academy of Clinical Biochemistry.

Applicant Signature(Required)

Date(Required)

Full mailing address(Required)

Street Address Address Line 2 City Province / State Postal Code / ZIP Country

Telephone(Required)

Email(Required)

Have you enclosed the following?

Original copy of application form
Copy of your CV
All supporting documentation, including copies of diplomas, certifications and degrees and continuing education relating to Clinical Chemistry/Biochemistry.
Fellowship reinstatement validation fee

Application Fee

Price:

GST

(Alberta, British Columbia, Manitoba, Northwest Territories, Nunavut, Saskatchewan or Yukon)

$ 0.00 CAD

HST

(Ontario)

$ 0.00 CAD

HST

(New Brunswick, Newfoundland and Labrador or Prince Edward Island)

$ 0.00 CAD

HST

(Nova Scotia)

$ 0.00 CAD

GST

(Quebec)

$ 0.00 CAD

PST

(Quebec)

$ 0.00 CAD

Tax

(Non-resident)

$ 0.00 CAD

Total

Credit Card(Required)

Card Details

Cardholder Name