CT(IAC) and CT(IAC-gyn) renewal form For sticker 2024-2027 Renewal for CT(IAC) and CT(IAC-gyn) 2024 - 2027 Sticker Requires information about the years 2020-2023. Required points 180 Step 1 of 5 20% For this form you will require: Information about your employment in the field of cytology for the years of your last stickerInformation about your personal attended further educational activities in the field of cytology and cytology related fields. If you have many activities please upload these as a separate document. Information about any teaching material you have created newInformation about any papers, posters or publications you have worked onInformation about cytology related researchContact InformationHiddenDate MM slash DD slash YYYY Your Given Name(Required)Given Name Your Family Name(Required)Family Name CT(IAC)/ CT(IAC)-gyn) number(Required) Your email(Required)Please enter your contact email Where shall we send your sticker? We need a correct postal address.Please enter a full postal address If you wish to have correspondence sent to your place of work please include the department as well as the institute name. The last line is always your country. Please do not try to fit your address on one line.Address Line 1(Required) Address Line 2 Address Line 3 City / Town(Required) Postal Code (If required) State / Region /ProvinceNot every address requires a state Country(Required)AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaCongo, Democratic Republic of theCongo, Republic of theCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFaroe IslandsFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabweOTHER CATEGORY 1 EMPLOYMENT IN CYTOLOGY (Max points 100)Name and address of Laboratory Director(Required)Category 1 Points for employment in the field of cytology (2020-2023)(Required) Full- time (100%) 100 points Part-time (60-90%) 75 points Part-time (50% or less) 50 points CATEGORY 2: YOUR PERSONAL EDUCATIONAL ACTIVITIES (Max. Points 140)We wish to know about your activities. Have you attended meetings, read specialist literature, taken part in courses, meetings, lab. internal learning? 1 point for 1 hour of your participation. If it is easier, combine events that are the same. (2022: 12 x lab reviews)If you require more space please upload your list as PDF and note the points below.Date, name of event(Required) Meetingname + DateCredit points(Required)Please enter a number from 1 to 50.Date, name of event(Required) Credit pointsPlease enter a number from 1 to 50.Date, name of event Credit pointsPlease enter a number from 1 to 50.Date, name of event Credit pointsPlease enter a number from 1 to 50.Do you wish to upload a list with further activities? no yes Upload a list of your educational activities(Required) Drop files here or Select files Accepted file types: pdf, jpg, png, docx, xlsx, Max. file size: 1 MB, Max. files: 2. How many points are on the uploaded sheet?Please enter the points you have noted on the uploaded list. Please enter a number from 1 to 150.Category Two - Your personal education points TOTAL CATEGORY 3: TEACHING MATERIAL YOU HAVE PREPARED (Max. points 60)Have you prepared any NEW teaching material?(Required)Workshops/ Lectures / Seminars No Yes One point for each hour of preparation time for NEW material for cytotechnology teaching.2020 - 2023Date, Type of event Credit pointsPlease enter a number from 1 to 30.Date, Type of event Credit pointsPlease enter a number from 1 to 30.Date, Type of event Credit pointsPlease enter a number from 1 to 30.Category 3 Teaching material you have prepared TOTALCATEGORY 4: PAPERS, PUBLICATIONS, BOOKS AND EXHIBITS (Max points 80)One point for each hours of preparation for new materialHave you prepared new material for publication?(Required) No Yes Date and Publication or Exhibit title(Required) Credit points(Required)Please enter a number from 1 to 30.Date and Publication or Exhibit title Credit pointsPlease enter a number from 1 to 30.Category 4 New material for publications TOTALCATEGORY 5: RESEARCH IN CYTOLOGY (Max points 40)Have you participated in research?(Required) No Yes Short summary of your personal research activities(Required)Category 5 Credit points for cytology research (max 40)Please enter a number from 1 to 40.Please describe the research and estimate your points. Maximum 40 points Summary (180 required)2020-2023Category 1 Employment in CytologyCategory 2 Your further educationCategory 3 New teaching materialCategory 4 PublicationsCategory 5 Research in Cytology2020 - 2023 Total pointsDeclaration of honesty(Required) I declare that to the best of my knowledge the above information is correct Total Points (180 required)If you have not attained 180 points please contact the office in Freiburg if you wish to explain your situation.After submit, you will be redirected to a payment portal. For CT(IAC) and CT(IAC-GYN) the renewal fee is Euro 12 and can be paid on-line by credit card or Paypal. CMIAC DO NOT HAVE TO PAY THE RENEWAL FEE: