Application form for Diploma in Cardiac POCUS

Thank you for your interest in the Cardiac Diploma Program.

The total program fee is USD 4,999 plus 6% bank/gateway charges.

The fee covers registration, access to all course modules, use of the case submission and review portal, faculty mentorship sessions, examination portal access, and issuance of the final certification and transcript.

Please note that payment is required only after your application has been reviewed and approved.

Kindly complete the application form below. Shortlisted applicants will be on the provisional candidates list and will be contacted by email with further details regarding payment procedures and program logistics.
Name

PrefixFirst NameLast Name
Primary Email Address

Confirmation Emailconfirm your primary email
Alternate Email Address
example@example.com
Mobile Number

Country CodeArea CodePhone Number
Institution Name
Your Current Job title
Hospital/Practice location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
No. of years in practice (Pediatrics/Neonatology combined):
Your Experience with POCUS
Do you currently use Point-of-Care Ultrasound (POCUS) in your clinical practice?
Years of using POCUS in your practice:
Your Experience in POCUS
What areas have you used POCUS for? (Check all that apply)
What ultrasound machines you have access to in your institution? (Please list all)
Your Previous POCUS Workshop Experience
Have you attended POCUSNEO Workshops before?
If yes, then When & Where:
Please provide your short bio
Please upload your headshot image

Cancelof
Additional Comments
Kindly share your learning goals and objectives when joining this training program
- Final Decision from the Selection Committee:
- Committee's Decision and Further Steps:
- Successful Applicants
  Congratulations on the successful review of your application.
  
  We are pleased to inform you that you have been provisionally accepted into the October 2026 Cardiac Diploma Cohort.
  
  To confirm your seat, please complete the registration payment using the link below:
  https://buy.stripe.com/eVqfZh75C9Hq50T3ihbwk01
  
  Registration Fee: USD 4,999 + 6% bank/gateway charges
  
  Kindly follow the on-screen instructions to complete the transaction. After completing the payment, please share the generated invoice with us. A formal confirmation email will be issued once the invoice has been received and verified.
  
  Please note that the registration fee is non-refundable.
  Payment Deadline: May 15, 2026, at 5:00PM EDT
  
  Provisionally accepted candidates will forfeit their provisional status if the registration fee is not received by the stated deadline.
  
  If you experience any technical difficulties during the payment process, please contact us at support@cnpocus.org.
  
  Once again, congratulations. We look forward to welcoming you to the October 2026 cohort.
  
  CNPOCUS Office Administration
- Unsuccessful Applicants
  Thank you for your application!
  
  You have been placed on the waitlist for the upcoming Cardiac Diploma Batch.
  
  We will notify you as soon as a seat becomes available. In the meantime, no action is required from your side.
  
  For any questions, please contact support@cnpocus.org.
  
  We appreciate your interest.
  
  Thanks
  
  CNPOCUS Office Admin
- Should be Empty:

Your Experience with POCUS

Your Previous POCUS Workshop Experience

Additional Comments