<p> Application for Re-Certification of European Certified Hand Therapist (ECHT)</p><p>Submissions for recertification must be submitted via E-mail to the ECHT Coordinator by November 30 of the year that your ECHT qualification expires.</p><p>Name: …………………………… …. Address: ……………………………. …………………………………………. Date of Birth: ………………………. …………………………………………. …………………………………………. Country of membership: Postcode: …………………………… …………………….. Tel No: ………………………………. National Membership number and qualification date…………….. E-mail: ………………………………. Recertification date...... OT / Physio: …………………………</p><p>Date and Number of last ECHT Date of Application: certification:</p><p>Included with Application (Please tick):</p><p> o Payment of 50 Euros to cover administration fees, payable to the EFSHT</p><p> o Verification of 2000 hours clinical practice since last certification (provide written statement detailing experience and number of hours in work settings) </p><p> 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. </p><p>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 </p><p>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.</p><p>Signed: ………………………………… Date: ……………………………..</p><p>ECHT Recertification Application Form February 2015 1 European Re- Certified Hand Therapist Contribution to Profession / Professional Accomplishments list</p><p>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.</p><p>Reminder Candidates must obtain a minimum of 30 points, in at least two of the five categories, to qualify for the ECHT recertification. </p><p>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. </p><p>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</p><p>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</p><p>ECHT Recertification Application Form February 2015 2 Total amount points achieved on self assessment </p><p>ECHT Recertification Application Form February 2015 3</p>