Application for Re-Certification of European Certified Hand Therapist (ECHT)

Submissions for recertification must be submitted via E-mail to the ECHT Coordinator by November 30 of the year that your ECHT qualification expires.

Name: …………………………… …. Address: ……………………………. …………………………………………. Date of Birth: ………………………. …………………………………………. …………………………………………. Country of membership: Postcode: …………………………… …………………….. Tel No: ………………………………. National Membership number and qualification date…………….. E-mail: ………………………………. Recertification date...... OT / Physio: …………………………

Date and Number of last ECHT Date of Application: certification:

Included with Application (Please tick):

o Payment of 50 Euros to cover administration fees, payable to the EFSHT

o Verification of 2000 hours clinical practice since last certification (provide written statement detailing experience and number of hours in work settings)

o Attached ‘Contribution to Profession / Professional Accomplishments’ self assessment table. Your must score a minimum of 30 points with achievements gained in the 7 years since ECHT certification.. Points must be achieved in at least 2 of the 5 categories.

Permission please tick below if you agree: o My name and country may be listed on the EFSHT website as a Therapist with the ECHT qualification

I hereby apply for re-accreditation as an European Certified Hand Therapist . I verify that this is a true and accurate representation of my clinical status and I am aware that this could be audited for further evidence by EFSHT.

Signed: ………………………………… Date: ……………………………..

ECHT Recertification Application Form February 2015 1 European Re- Certified Hand Therapist Contribution to Profession / Professional Accomplishments list

Please list your professional accomplishments and contributions to the field of Hand Therapy gained during the last 7 years since certification. Please refer to the point allocation document for contributions to the profession, when completing this table, please add additional lines under the categories if you need space.

Reminder Candidates must obtain a minimum of 30 points, in at least two of the five categories, to qualify for the ECHT recertification.

Please note: Final evaluation of the application and evidence rests with the assessors. Assessors may perform an audit and request evidence from the candidate to support the points claimed.

Please include the type of activity using the following category abbreviations  Continuing Education CE  Instructional Activity IA  Research Activity RA  Publications P  Organizational Activity OA

Description of Activity Points claimed Date Activity Description of activity category 1.1.201 IA EXAMPLE: Taught a 1 day workshop, titled “Splinting for the 3 5 PIP joint”, 30 participants, course was taught in Sample City , Country

ECHT Recertification Application Form February 2015 2 Total amount points achieved on self assessment

ECHT Recertification Application Form February 2015 3