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Apply for a full membership
Fill in the application below, along with all your supporting documents, to apply for a full membership.
Name
First name
Last name
Personal details
Personal home address line 1
Personal home address line 2
Personal home address city / town
Personal home address region
Personal home address post code
Personal home address country
Personal phone number (not your public practice/business phone if applicable)
Personal email address
Date of birth
Gender
Male
Female
Gender diverse
Ethnic origin
If you are of Māori descent please supply the following:
Iwi
Rohe (iwi area)
Declarations
I hereby apply to become a full 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?
Select one...
Yes
No
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 also supply a copy of your academic transcript showing the courses in your training.
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Max file size 10MB.
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A copy of your CV or a brief description of your work history.
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Max file size 10MB.
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A copy of your current Annual Practising Certificate.
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Max file size 10MB.
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Using this template, your supervision contract for the year ahead.
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Max file size 10MB.
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Supervisor Report, using this template, from a NZ Registered Clinical Psychologist for the last 12 months of clinical practice.
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Max file size 10MB.
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Using this template, references from two New Zealand registered psychologists who have known you for 6 months or more and have agreed to comment on your professional standing.
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Practice details
The following information will help NZCCP to support you and your practice.
Business Phone (Practice Phone)
Business Email (Practice Email)
Practice Name
Practice Address Line 1
Practice Address Line 2
Practice Address City / Town
Practice Address Region
Practice Address Post Code
Practice Address Country
Practice Published Region
Auckland
Alexandra
Blenheim
Cambridge
Christchurch
Cromwell
Dunedin
Franz Josef
Gisborne
Hamilton
Invercargill
Kapiti
Kerikeri
Lower Hutt
Lower Hutt and Wellington
Marlborough
Masterton
Mt Maunganui
Napier
Nelson
New Plymouth
Online/Teletherapy
Palmerston North
Paremata/Porirua
Petone
Queenstown
Rotorua
Russell
Taranaki
Tauranga
Tauranga/Mt Maunganui
Timaru
Turakina
Upper Hutt
Waikato
Wairarapa
Wanaka
Warkworth
Wellington
Wellington and Nelson
West Coast towns (Westport, Greymouth, and Hokitika)
Whakatane
Whanganui
Whangaparoa
Whangarei
Client types
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What languages, other than English, do you use professionally with clients?
What are your specialist areas?
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What are your treatment types?
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Please indicate how many FTEs you work and in which employment setting(s):
ACC Sensitive Claims
Child, Youth & Family
Department of Corrections
District Health Board
Iwi Health Provider
NGO
NZ Defence Force
PHO
Private Practice
University setting
Other (please specify)
Professional Indemnity
The Medical Protection Society (MPS) provides an indemnity insurance scheme for NZCCP members.
Download the Medical Protection Society (MPS) Application Form
or email
office@nzccp.co.nz
for more information.
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