ANZAP Membership Application Form

APPLICATION CHECKLIST

Before sending this form please check that you have the following documents to upload (PDF or JPG formats accepted):

Certified documentation of your psychotherapy qualifications.
Documentation of your post-qualification supervision.
A certified copy of your Professional Indemnity Insurance.
The contact details of referees.
You have paid the $50 application fee PRIOR to submitting this form. If you have already made your payment, proceed with completing the application form below.

Westpac:

BSB: 032-069 | Acc: 469778

Please use your SURNAME as the identifier when making your payment

CLICK HERE Pay the $50 Application Fee

New Zealand CLICK HERE to make your payment

The Membership Secretary makes a recommendation to the Executive Committee of ANZAP. The final approval is at the discretion of the Executive Committee. You will be notified by email whether or not your application has been successful.

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Apply for membership

Required *

Applicant Information

First name

Last name

Preferred street address

Contact Information

Confirm email

Preferred phone number

Membership Category

For which membership category are you applying?

Membership Category

Professional background

What do you currently do professionally?

(Please include details of your work role elaborating any psychodynamic psychotherapy practice in which you are engaged and how long you have undertaken this role)

Current Profession

What relevant positions have you formerly held?

(Please elaborate psychodynamic psychotherapy or related work posts you have held prior to your current role including dates and duration

Relevant positions held

Are you a member of any professional associations or bodies?

Please list together with the period of time you have held such memberships.

Professional associations

Are you registered with any professional organisations (medical board, nursing board, APS, etc)?

Please list together with period of time registration has been held.

Professional organisations

Academic Qualifications

Please state your qualifications, including year obtained and name of University or College.

Academic qualifications

Professional Practice (past 2 years)

How many hours of psychodynamic psychotherapy do you do per week?

What percentage of this is your overall practice?

If you are a supervisor, how many therapists do you supervise?

How many hours do you supervise therapists each week?

Publications

Training and experience in psychotherapy

1. Psychotherapy Qualification:

Post Graduate: Please attach documentation showing that you have completed a post-graduate course in psychotherapy that has included at least 200 hours of didactic teaching, and at least 100 hours of supervision linked to 150 hours of patient/client hours over a minimum of 3 years. You will need to attach certified* copies of your qualification and academic record. Please ensure details show the modality of the psychotherapy training eg psychodynamic, CBT etc

*certified means a copy signed by a Justice of the Peace. You will need to take the original as well as the copy. JPs are usually found Post Offices/Police Stations/Local Court Houses

Are you uploading documents of your Post Graduate qualifications?

YesNo

Upload Post Graduate qualifications

Upload Post Graduate qualifications (2)

Upload Post Graduate qualifications (3)

Required Prior Learning (RPL): Please attach certified documentation of the credentials and experience that demonstrates equivalence to the post-graduate pathway. This is primarily for those therapists who trained before the availability of the current courses.

Are you uploading documents of your Required Prior Learning?

YesNo

Upload Required Prior Learning (RPL)

Upload Required Prior Learning (RPL) (2)

Upload Required Prior Learning (RPL) (3)Clear Selection

2. Post-Qualification Supervised Practice:

Please provide documentation that you have had at least 2 years of post-qualification supervision (and the type of supervision undertaken eg psychodynamic, CBT etc).

Are you uploading documents of your Post-Qualification Supervised Practice

YesNo

Upload Post-Qualification Supervised Practice

Upload Post-Qualification Supervised Practice (2)

Upload Post-Qualification Supervised Practice (3)

3. Personal Therapy

Have you had personal therapy?

YesNo

How many years of personal therapy have you had?

Was this psychodynamic psychotherapy?

YesNo

Please specify the other personal therapy you have had.

What was the frequency of your personal therapy?

Was therapy undertaken concurrently with your psychotherapy training?

YesNo

Reasons for applying for membership

Please indicate why you are seeking membership of ANZAP.

What do you hope to gain from Membership of ANZAP?

Ethics

Please read ANZAP Current Code of Ethics and sign the following statement.

Read the ANZAP Current Code of Ethics here.

I agree that If accepted as a member of ANZAP I will abide by the ANZAP Frame of Ethics, including the Map of Ethics and the Code of Ethics.

Date

Do you have any unresolved ethical complaints or criminal convictions made against you, either currently or in the past?

YesNo

Please specify any unresolved ethical complaints or criminal convictions made against you.

Have you had any complaints upheld against you in the past?

YesNo

Please specify any complaints upheld against you in the past?

Professional Indemnity

Please provide a certified copy of your current Professional Indemnity Insurance.

Upload a certified copy of your current Professional Indemnity Insurance

Professional Referees

Please give the name, address, email and telephone number of referees who will be contacted. It is preferable that one should be an ANZAP member of more than five years standing.

NB: Your therapist cannot be a referee.

Referee 1

Referee 1 Name:

Referee 1 Address:

Referee 1 email:

Referee 1 phone:

Do you have additional referees?

Referee 2

Referee 2 Name:

Referee 2 Address:

Referee 2 email:

Referee 2 phone:

Referee 3

Referee 3 Name:

Referee 3 Address:

Referee 3 email:

Referee 3 phone:

Agreement of applicant.

I agree that the information I have supplied in this form is accurate.

Yes

Agreement date

Captcha

ANZAP Membership Application Form

APPLICATION CHECKLIST

The Membership Secretary makes a recommendation to the Executive Committee of ANZAP. The final approval is at the discretion of the Executive Committee. You will be notified by email whether or not your application has been successful.

Make a donation

Apply for membership

Applicant Information

Contact Information

Membership Category

Professional background

Academic Qualifications

Professional Practice (past 2 years)

Publications

Training and experience in psychotherapy

CONTACT ANZAP

Courses

About ANZAP

First Point of Contact