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Recertification Application form for the FSRH Diploma

This self-declaration form is to support the recertification of the FSRH Diploma. It should be completed and submitted no sooner than 6-months prior to your recertification deadline. Please refer to the DFSRH information for guidance and requirements.

To recertify you need to confirm you have achieved the following Continuing Professional Development credits and activities over the past five years.

Please refer to recertification information for details regarding recertification during the Covid-19 pandemic. 

The information you have shared on this form will be used by the relevant FSRH Committee and FSRH staff for the purposes of administration only. FSRH will keep this information securely on our systems. Our full privacy policy can be viewed here.
All intellectual property rights for any FSRH qualification including documents, materials and content belonging to and produced by the FSRH should not be used for purposes other than FSRH training. Should you wish to use any of the IPR for purposes other than FSRH training you must seek the FSRH’s approval in writing with your request via our copyright request form. We aim to respond to submissions of this nature within one working week.

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Personal Details

Please complete all details about your personal details to ensure that we can accurately record your recertification on our systems. 

As used with your MyFSRH website account.

CPD Requirements Section One

To recertify you need to confirm you have achieved the following Continuing Professional Development credits and activities over the past five years.

I have gained at least 10 CPD credits within 5 years of my recertification date OR 15 credits in the case that my recertification application is more than six months past my recertification due date.*
Personal Beliefs Guidance

Please see the recertification section of the FSRH website to read the “Guidance for those undertaking or recertifying FSRH qualifications whose personal beliefs conflict with the provision of abortion or any method of contraception”. This was introduced at the FSRH in June 2017 and you should read this before submitting your recertification application. You are asked below to confirm you have read the guidance and will abide by the principles in it in your practice. This is part of the Faculty’s conditions for recertifying a FSRH qualification.

By checking the box below I confirm I have read the 6 principles of care as outlined in the “Guidance for those undertaking or recertifying FSRH qualifications whose personal beliefs conflict with the provision of abortion or any method of contraception” and agree to abide by them in practice.

 

I confirm I have read the FSRH Guidance for those undertaking or recertifying FSRH qualifications.*
Self Certification

By checking the box below I declare I have met the requirements to recertify my FSRH Diploma.  I understand the FSRH may request supporting evidence of my CPD. I am willing to provide any requested supporting evidence. I understand that if I am found to be making a false declaration it may result in the removal of my FSRH qualification and potential further action may be taken with my employer and/or regulatory body.

I declare I have met the necessary requirements and will provide evidence if requested.*
Verification

Please click the box to indicate you are a human rather than an automated system completing this form.

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