ARCS Competency Portfolio

Please use this form to apply for the ARCS Competency Portfolio.

ARCS Competency Portfolio application form

Your ARCS Membership number:*

Personal Details

Title:*

Surname/Family Name:*

Forenames / Given Name:*

Email Address:*

Telephone Number:*

Employment Details

Current Position (Job Title):*

Employer:*

Employer Address:*

Most recent education award, certificate or diploma

Enter your most recent educational award, certificate or diploma

Name of Award:*

Awarding Body:*

Subject(s) of award:*

Institution:*

Date Awarded:*

Period of Study (Start and Completion Date):*

Current Role (or most recent) post

Employer:*

Current Position (Job Title):*

Your duties and responsibilities:

Core Module information

Laboratory Practice in the HFEA-Licensed Reproductive Science Laboratory
Principles and Organisation of Services in the HFEA-Licensed Fertility Clinic
Reproductive Sciences: Human Body

Task-based module information

You will be sent information on applying for these once you have completed 3 core modules.

Procedures for Witnessing in the HFEA Licensed Fertility Clinic
Monitor and maintain the cryopreservation facility in the HFEA-licensed Fertility Clinic
Identify and instruct males providing semen samples in the HFEA-Licensed Fertility Clinic
Monitor air quality in the HFEA-Licensed Fertility Clinic
Check documentation of consent in the HFEA-Licensed Fertility Clinic
Check documentation of test results in the HFEA-Licensed Fertility Clinic
Semen assessment in the context of the HFEA Licensed Fertility Clinic
Prepare culture systems for gametes and embryos in the HFEA-licensed Reproductive Science Laboratory
Prepare documents for the transport of gametes and embryos to and from other Fertility Clinics

Person responsible to HFEA in Training Centre

Enter your most recent educational award, certificate or diploma

Name of Award:*

Appointment:*

I support the application of the candidate, and state that the facilities available to the candidate comply with the following regulations:

That the clinic has a current HFEA licence. Please Provide HFEA License number (below)
That the candidate has worked in this clinic for the period of time stated.
That the laboratory has facilities and resources suitable for the completion of the modules
That the supervisor is appropriately trained, qualified and is registered as a Clinical Scientist with the Health and Care Professions Council, has sufficient experience, and will devote the necessary time to ensure proper supervision of the candidate.

HFEA License Number:*

Signed:*

Date:*

Embryologist willing to act as Personal Supervisor

I am HCPC registered with 2 years further experience as a clinical or biomedical scientist and have approval to act as supervisor from the person responsible. I agree to ensure that the equipment/consumables and written protocols will be made available for training purposes to comply with the Health and Safety at work Act (1974), COSHH (1990) and HFEA regulations. Where appropriate, I agree to provide time for the trainee to complete the modules requested. And that the evidence supplied for assessment will be the candidate's own work.

Name:*

Employer:*

Address for correspondence:*

Email for correspondence:*

ARCS Membership number:*

(please ensure you maintain your ARCS membership)

HCPC Registration (Clinical Scientist Number):*

Date:*

Declaration by Supervisor

I am willing to act as Personal Supervisor for:

Trainee Name:*

Signature:*

Date:*

I have read and agree to the ARCS Modular Competency Portfolio .

I understand the regulations of the ARCS Competency Portfolio Scheme .

Declaration by Applicant

I wish to register for the core modules.

I understand that ARCS receive payment to process my application, which is non-refundable.

I will receive the module documents and assessment document for each module.

A letter(s) of achievement will be awarded on successful completion of each core module.

I will receive certification on completion of all 3 core modules.

I agree to the regulations of the scheme and to submit module evidence with the signed declaration form provided with the module paperwork

I agree to uphold the dignity and reputation of the profession of Clinical Embryology and to exercise professional skill and judgement to the best of my ability and to discharge my professional responsibilities with integrity.

I understand that Portfolio fees and ARCS membership fees are payable for the duration of the training period. A current ARCS membership should be in place for a letter or Certificate to be provided.

I undertake to inform the ARCS Secretariat immediately if I wish to request a variation in my training, for instance a period of absence from work or a Supervisor change.

I have read the regulations and policy above and will comply with the regulations for the ARCS Competency Portfolio.

I certify that the information given on this application form and in any attachment is correct to the best of my knowledge and belief.

Should it be necessary to change supervisor then the ARCS secretariat must be informed and approve the new supervisor.

Signed:*

Date:*

I agree to the ARCS Competency Portfolio Regulations and Policy .