Application: Authorization to Use Needles
Applicant name
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Email
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(Same email that is on file with the College of Physiotherapists of Alberta)
Registration number
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Details of post entry-level education program
Name of program
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Country where program was completed
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Year program was completed
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Detailed description of theoretical component of program
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Detailed description of practical component of program
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Detailed description of safety instruction/content covered in the program
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Detailed description of final evaluation method or process
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Certificate(s) of completion (PDF)
*
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Declaration statements
I declare I have completed a post entry-level needling education program that includes as part of the curriculum: theory, practice, safety instruction and final (summative) evaluation conducted by the course instructor which resulted in a passing grade.
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Yes
No
I declare I have read, understand and agree to comply with the practice standards related to the performance of restricted activities.
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Please Select
Yes
No
I certify and declare that the information provided in this application is true.
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Please Select
Yes
No
Submission
Signature
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