Apply for an associate membership

Name

First nameLast name

Personal details

Personal Home Address Line 1Personal Home Address Line 2Personal Home Address City / TownPersonal Home Address RegionPersonal Home Address Post CodePersonal Home Address CountryPersonal phone number (not your public practice/business phone if applicable)Personal email addressDate of birthEthnic origin

If you are of Māori descent please supply the following:

IwiRohe (iwi area)

Declarations

I hereby apply to become an associate member of the New Zealand College of Clinical Psychologists. I also make the following declarations:

I am a New Zealand Registered Psychologist (Clinical Scope of Practice) and hold a New Zealand D.Clin.Psy. OR a New Zealand Masters/PhD and P.G.Dip.Clin.Psych. OR what I believe to be an overseas clinical psychology qualification equivalent to the above. *I agree to abide by the Rules of the College. *

Have you ever been the subject of any complaint to the Health and Disabilities Commissioner, the New Zealand Psychologists Board or an equivalent overseas body?

If yes, you agree to provide details of the complaint to the President of the NZCCP and authorise the agency to whom the complaint was made to release all records and information pertaining to the complaint to the President of the NZCCP for the purposes of assessing your eligibility to be a member or associate member of the NZCCP. Please supply details addressed to the President, C/o office@nzccp.co.nz and marked “Confidential”.

The above information is true and accurate. *

Upload files

Please upload the following files to support your application process.

A copy of your Degrees or Diplomas, or other proof of qualifications. If you trained overseas, please download this template and also supply a copy of your academic transcript showing the courses in your training.

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