Association Of Psychotherapists And Counsellors (Singapore) Membership Application Form A. Personal Information Name * (Mr / Mrs / Mdm / Ms / Dr / Prof) Email * NRIC/ Passport No. * Date of Birth (mm/dd/yyyy) Age * Nationality * Citizenship Status * SingaporeanPROthers Postal Code Address (Residence) * Phone (R) Phone (O) Phone (Mobile) * Gender MaleFemale Marital Status SingleMarriedSeparatedDivorcedWidow Race * ChineseMalayIndianEurasianOthers Language B. Educational Attainment (Please Enclose A Copy Of Your Transcript) Name of Institution /University Diploma / Degree Conferred Major Year Graduated Add New C. Skills Development In Counselling / Psychotherapy Name of Workshop / Seminar / Courses Attended Duration Year Remarks D. Employment History Order them in chronologically order, starting with your most recent experience. Name of Organisation Position Date Joined (mm/dd/yyyy) Date Left (mm/dd/yyyy) I currently work here E. Present Job Description Maximum 500 characters limit F. Community Involvement(s) Name of Organisation Position Held Period Paid or Voluntary G. Practicum Hours Click here to download APACS Logbook Name of Organisation Site Supervisor Hours H. Clinical Supervision Hours Name of Supervisor Hours I. Type Of Membership Applied For Ordinary Member S$50.00 Life Member S$800.00 (one-time payment) Associate Member S$40.00 Student Member S$30.00 Corporate Member S$200.00 Note: Registration fee S$50.00 (one-time non-refundable payment) Click Here to view membership category information * Reinstatement fee for lapse member is S$100.00 together with payment of all dues in arrears. Those who wish to re-apply for membership shall have their application treated as a fresh application and shall be subjected to the approval of the prevailing Executive committee. J. Accreditation Level (License Practitioner) Applied For Level 1: Certified Practitioner Basic relevant degree with 150 hours Supervised practicum Level 2: Certified Practitioner Basic relevant degree with 300 hours Supervised practicum Annual fee: S$50.00 Level 3: Certified Master Practitioner Basic relevant Masters Degree with 300 hours Supervised practicum Annual fee: S$80.00 Level 4: Certified Master Practitioner Basic relevant Masters Degree with 500 hours Supervised practicum Annual fee: S$100.00 Level 4/S: Certified Master Practitioner / Supervisor Annual fee: S$120.00 Educator: For applicant who wish to join as member but do not intend to practice as counsellor or psychotherapist No additional fee Remark: Maximum 300 characters limit K. Proposed By Two Current APAC (S) Members of Good Standing No Name of Proposers (current APAC (S) members of good standing) Membership Number Email 1 2 L. Summary Of Application Once your application is successfully accepted, the secretariat will notify you to process the fee payment via the following methods, a) For cheque deposit, issue crossed cheque in favour of APACS and mail to address: BLK 124, Hougang Ave 1, #01-1450, Singapore 530124. b) For ATM Fund Transfer / Internet Bank Transfer Payment, please transfer the due amount to the following bank account. DBS Current Account No: 104-900009-5 Bank Code: 7171 Branch Code: 104 Swift Code: DBSSSGSG Please enter your Name in the "Payer" field when performing an internet bank transfer. Once the fund transfer payment has been effected, please submit a payment notification with the following details to the email@example.com to facilitate us in tracking your payment. - Mode of Payment: - Date of Payment: - Time of Payment: - Reference/ TransactionNumber: M. Applicant Not Meeting Entry Criterion Applicants who do not meet the entry criterion may still apply and be admitted as member upon approval of the Executive Committee and after fulfilling other requirements. This will be on a case to case basis and should not be constituted as a precedent. N. Check If You Have Completed The Following Before Submission Upload your photo * Maximum file size limit: 1MB and supported only for JPG, PNG, GIF files. Upload your documents Maximum file size limit: 2MB each and up to 5 files. Supported only for PDF, DOC, DOCX, JPG, PNG, GIF files. x x x x Add file I have uploaded my Transcripts & Certificates. (Non-submission of documents may result in a rejection of your application) I have uploaded the documentary proof of practicum. O. Declaration I declare that: The information stated above is accurate and true to the best of my knowledge. Upon acceptance as a member, I shall uphold the constitution, code of ethics, code of conduct and behavior and conform to the Manual of Procedures of the Association to the best of my abilities. I have not been charged with any criminal offence(s) in any court of law. I have read and understand the terms & conditions of my membership. Applicant’s Signature Date P. Webpage Inclusion Specialised Skills Client Categories Survey on Area Of Interests (I) Area of speciality (you may indicate more than one) Abuse casesAdolescents riskADHDChildren with disabilitiesDepressionDyslexiaElderly RehabElderly issuesEnd of life issuesFamily issues / ViolenceGerontologyGeriatricsMarriage issuesMental health issuesPalliative carePrison rehabSleep disorderSuicideSubstance / behavior addictionTrauma Others (II) To enhance my counselling / psychotherapy skills, I would be keen to attend workshops, lectures and courses related to the following topics: Maximum 300 characters limit It may take a few minutes for uploading the files.