Booking Form: Healing Together Facilitator Programme

Would you like to renew your Healing Together Accreditation?*

YesNo
Are you sure?

By selecting "No", this will mean that you will not longer be an Accredited Healing Together Facilitator. Your access to the Healing together resources and programme materials will end on your renewal date and after this date your access will be suspended and you will no longer be authorised to deliver any Healing Together programmes.

Please enter your name and email address below to confirm that you would like to cancel OR if you made a mistake, change your option above.
Confirm Renewal

By selecting "Yes", you are applying to maintain your Healing Together Accreditation.

Your access to the Healing Together resources and programme materials will renew on your renewal date subject to your application being approved.

Please enter your name and email address below to confirm that you would like to renew OR if you made a mistake, please change your option above.
Name

First NameLast Name
E-mail address*
IMPORTANT! Please use the email address associated with your membership
Please provide further information as to why you will not be renewing your accreditation?*
Healing Together Facilitator Number*
This is the reference number associated with your Healing Together account. You'll find it on most email correspondence from us.
Accreditation Statement - CPD Details

Please confirm that you have fulfilled the requirements of your accreditation (this CPD training does not need to be have carried out in partnership with Innovating Minds)
I have undertaken at LEAST ONE CPD training in the past 12 months*

YesNo
Date and Description of CPD training undertaken*
Accreditation Statement - Access to Supervision

Please confirm if you receive access to Supervision as part of your role and offered by your Organisation (this is not Clinical Supervision or any other support/supervision as offered by Innovating Minds)
I have accessed professional supervision during the past 12 months*

YesNo
Accreditation Statement - Programme Delivery

Please confirm that you have fulfilled the requirements of your accreditation.
I have delivered and submitted evaluation forms for AT LEAST TWO Healing Together programmes over the past 12 months*

YesNo
Note: We will verify your programme delivery by searching our database for participant evaluation forms that have been submitted by you. If you have successfully delivered a Healing Together programme but not yet submitted your evaluation forms, please ensure that you do this from within the Healing Together Portal before submitting your renewal form.

If your answer to the above is 'No', then please email healingtogether@innovatingmindscic.com to provide some background as to why you have been unable to deliver. Failure to do so will delay the processing of your renewal request.
Renewal Summary

Thank you for submitting your information, below is a summary of your submission.

I confirm that the details I have submitted in this form are true and accurate*

Please tick to confirm
Confirm Cancellation

Should be Empty:

Would you like to renew your accreditation?	{wouldYou}
Facilitator Name	{name}
Facilitator Email address	{emailAddress}
Completed CPD?	{iHave87}
CPD Details	{dateAnd}
Accessed Supervision?	{iHave102}
Delivered at least one programme?	{iHave96}

Would you like to renew your accreditation?	{wouldYou}
Member Name to be cancelled	{name}
Member Email address	{emailAddress}
Facilitator Reference Number	{healingTogether}

Accreditation Statement - CPD Details

Accreditation Statement - Access to Supervision

Accreditation Statement - Programme Delivery

Renewal Summary

Confirm Cancellation