• Student Membership

    Student Membership

    Application Form
  • (Insured and Non Insured): A student enrolled in an accredited graduate degree in counselling, psychology, or other mental health discipline. 
     
    Application Document Checklist:
    1.  Current transcript from your graduate or doctoral degree showing current enrollment.

    2.  Resume/C.V.

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

    4.  If wanting insurance, a completed liability insurance forms.

    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 Student membership application to PACCP.
     
  • Title*

  • Sex*
  • Membership Applying for:*
  • 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?*

  • If you are applying for Student-Insured status, have you completed a minimum of a 2-year degree program with all required courses? For programs of study that are longer than 2 years, students must have completed a minimum of 90% of the required coursework in that program in order to qualify for insurance through PACCP.

  • Transcript*
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  • VOCATIONAL INFORMATION
  • Resume/CV*
  • Select File
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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
     
  • Select File
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  • LIABILITY INSURANCE
  • Would you like to enrol in PACCP"s group liability insurance policy?*
  • Liability Insurance Application Forms*
  • Select File
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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*
  • Select File
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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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