PGY2 Extension Flagging Form

This field is for validation purposes and should be left unchanged.
This form is intended for notifying PMCV of an anticipated PGY2 extension identified during the year. This extension might be anticipated because of a delayed start (either through a PGY1 extension or other reason), excess leave or concerns regarding meeting the outcomes required for awarding the Prevocational Certificate.

Completion of this form does NOT indicate that an extension is proceeding but serves to notify all parties for planning purposes.

If an extension is being pursued, a complete application must be submitted using this form by December of the calendar year in which the PGY2 begins.

If you need assistance please contact the Accreditation team on: accreditation@pmcv.com.au

Health Service Contact Details

Contact Name(Required)

Health Service details

CMO/DMS Details

CMO or DMS?(Required)
CMO/DMS Name(Required)

Details of PGY2

PGY2 Name(Required)
Reason for extension(Required)
select all applicable

Additional Comments or Documentation

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