• Allied Professional Membership

    Allied Professional Membership

    Application Form
  • Christian clinicians from other professions such as Music or Art Therapists, Social Workers, Guidance Counsellors, Addictions Counsellors, Pastoral Care providers, etc. who are certified with their particular professional association, and who support PACCP’s mission and vision and agree to the Statement of Beliefs.
     
    An Allied-Professional member must prove that they carry adequate liability insurance and does not have voting privileges.
     
    Application Document Checklist:
    1.  Transcript from your graduate or doctoral degree.

    2.  Resume/C.V.

    3.  Criminal/Vulnerable Persons Check (no more than 1 year old)

    4.  Proof of active membership in another association which has a continuing education equivalent equal to or great than PACCP's; if it doesn't, you may choose to participate in PACCP's continuing education program to fulfill this requirement.

    5.  Have your references complete the online reference forms or submit by email to paccp@paccp.ca

    6.  If you answered yes to any of the Statement of Professional Ethics & Conduct question, please submit further explanation to our office.
     
    Please email paccp@paccp.ca the above documents to be supportive of your application for membership or upload them in the appropriate sections of the application.
  • Please fill out the below information to submit your Allied Professional membership application to PACCP.
     
  • Title*

  • Sex*
  • MAILING ADDRESS (for PACCP office use only)
     
  • How did you find out about PACCP?

  • EDUCATIONAL INFORMATION
  • Please provide information in regards to your counselling or related field of education only.
  • Transcript, Association Proof such as Certificates, & Insurance Proof*
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  • VOCATIONAL INFORMATION
  • Resume/CV*
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  • REFERENCES
  • Please provide name, email address, relationship to you, and contact phone number for each reference.  References submitted online are recommended/requested to speed up the approval process.  However, they may also email a letter of reference to paccp@paccp.ca
     
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  • STATEMENT OF PROFESSIONAL ETHICS AND CONDUCT
  • Are you currently under investigation for alleged unethical/unprofessional conduct?*

  • Have you ever been disciplined by a professional association or regulatory body for unethical/unprofessional behaviour?*

  • Have you ever been charged with a criminal offence and/or convicted of an indictable offence?*

  • Have you ever been charged or convicted of any other offence (e.g., summary conviction or petty offence)?*

  • Has any claim/allegation been made against you in a civil suit or any other forum which clearly alleges unethical behaviour on your part including, but not limited to, the following: sexual intimacy with a client, a dual relationship with a client, violation of confidentiality, etc.?*

  • Have you ever been dismissed from employment or refused membership in a professional association ore registration in counselling or a related field, on the grounds of professional misconduct in Canada or elsewhere?*

  • Have you ever voluntarily given up privileges, registration, certification, or license to practice psychology, or agreed to restrict your practice in lieu of, or to avoid, formal action?*

  • CRIMINAL RECORD CHECKS
  • Please provide a copy of your Criminal Record Check; including Vulnerable Persons search (no more than a year old).
  • Criminal Check*
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  • MEMBERSHIP AGREEMENT
  • I have read and understand the following and agree to abide by and adhere to them (Please check):*
  • I also give my permission for an authorized representative of PACCP to contact my supervisor or any other professional reference whom I have nominated to support this application, for verification purposes. I also affirm that the information provided in this application is accurate and true.
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • PAYMENT INFORMATION

  • You must make payment of your application fee of $50 now.  This is a one time fee only.

    Once all your documents are received, and your application is reviewed by the Applications committee, you will be notified that payment of the membership and insurance fee (if applicable) is now due.  You will be sent an invoice which you may pay by credit card online at that time.

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