• Certified Professional Counsellor Supervisor (CPCS)

    Certified Professional Counsellor Supervisor (CPCS)

    Application Form
  • In addition to meeting all entry level membership requirements for Associate Professional Counsellor (APC) membership, CPCS's have completed additional post-graduate experience including a minimum of 500 directly client contact hours and 75 hours of Supervision with a qualified supervisor.

    AND have completed a formal course in Supervision Fundamentals (at least 30 hours in length),

    AND have completed a minimum of 30 hours of supervision of your own supervision practice with a qualified Supervisor.  Up to 25% of these hours can be group supervision, the remaining hours can be in individual or dyadic supervision. 

    **A currently Certified member can request Supervision in Training status, after the completion of the Supervision Fundamentals course so that completion of the Supervision of Supervision hours can take place.**
     
    Application Document Checklist:
    1.  Transcript from your graduate or doctoral degree completed in relation to counselling, psychotherapy or other mental health field.

    2.  Resume/C.V.

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

    4.  Completed liability insurance forms or provide proof of your own insurance which equals or is greater than $5,000,000 liability coverage

    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.
     
    7.  If you are not currently a PACCP APC member and are strictly a NEW applicant, then you must also submit verification of your directly client contact hours and supervision hours, in the form of a log or signed letter from your Supervisor.  Ensure you indicate the dates these hours were accumulated from.  If there were more than one supervisor, please submit verification from each.  These must be POST-graduate hours. 
     
    IF you are a current PACCP CPC member, you do not need to fill out this application form.  Just submit your proofs right to the PACCP office directly at paccp@paccp.ca
     
    8.  Need a letter of verification from Supervisor(s) stating that they have taken a formal course in Supervision Fundamentals, and have had a minimum of 30 hours of Supervision of THEIR Supervision.  This passes our "qualified supervisor" test.
     
    9.  Proof of completion of Supervision Fundamentals course (at least 30 hours in length)
     
    10.  Proof of completion of 30 hour of Supervision of your Supervision, verified by the Supervisor.
     
    Please email paccp@paccp.ca the following 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 Certified Professional Counsellor Supervisor (CPCS) 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.
  • Is this Institution accredited through a recognized accrediting authority as listed on PACCP"s website?*
  • Have you completed a graduate level course in Counselling Professional Ethics (either as part of your program or post-grad)?*
  • Have you completed the required 100 Supervised hours (internship/practicum) of client contact as part of your graduate program?*

  • Transcript*
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  • VOCATIONAL & CERTIFICATION INFORMATION
     
  • Are you currently a practicing counsellor?

  • Resume/CV*
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  • CPC Hour Proof*
  • CPCS Proofs*
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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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  • LIABILITY INSURANCE
  • Would you like to enrol in PACCP"s group liability insurance policy?*
  • Liability Insurance Application Forms*
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  • Proof of Insurance if purchased on your own
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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 CHECK
     
  • 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 $75 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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