MEMBER. Application for election MEMBER, NEW GRADUATE. psychology.org.au. April 2015

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1 MEMBER Appliation for eletion MEMBER, NEW GRADUATE April 2015 psyhology.org.au

2 MEMBER Belonging to the Australian Psyhologial Soiety (APS) means you are part of an ative, progressive organisation whih is advaning the standard and reputation of the psyhology profession and disipline aross Australia. It means you an onnet with over 21,000 members aross the nation a vast network of psyhology pratitioners, researhers, eduators, onsultants and students. Beoming an APS Member means you are eligible to use the post-nominal MAPS, enabling instant reognition of your status within the field of psyhology. To attain the grade of Member of the APS by the standard route you must have ompleted an APAC (Australian Psyhology Areditation Counil) aredited four year undergraduate sequene of study in psyhology, and either: a) a two or three year APAC-aredited postgraduate oursework degree; or b) a postgraduate researh degree (minimum two years full-time study) in psyhology. You may also be eligible to apply via the non-standard route to the grade of Member if your experienes do not fit those desribed above (please use this form). APS member benefits and servies Members of the APS are entitled to a large range of benefits and servies, inluding: InPsyh: Bimonthly publiation keeping you informed about topial psyhologial issues and up to date in the fast-hanging world of psyhologial pratie, researh and eduation. APS Matters: Fortnightly update providing the latest news and alerts, advoay updates, professional resoures and CPD opportunities. APS website: Member-only aess to the latest information, media releases, professional resoures and upoming events at psyhology.org.au. Responsive telephone advisory servies: Individual responses to your queries about professional pratie, legal and ethial onerns, as well as national registration requirements. APS Code of Ethis and Ethial Guidelines: Valuable ethis resoures for pratitioners and researhers, providing guidane in various ontexts and with various lient groups. EQIP: Member-only aess to a searhable database of online psyhologial assessment and treatment resoures aross a range of psyhologial onditions. Continuing professional development (CPD): Member rates to a large range of CPD events and online learning programs from the APS Institute and APS Member Groups, as well as a suite of APS Conferenes throughout the year. CPD logging: Online logging system enabling monitoring of individual CPD requirements related to national registration, Mediare provider and APS membership. Online aess to psyhology literature database and APS journals: Free online aess to APS journals (inluding all bak opies) and psyhology literature databases. Disounted books: Up to 35% disount on text and referene books in the Wiley atalogue. Professional networking: Failitated aess to like-minded olleagues and ommunities of interest through APS Member Groups aross Australia, as well as supervision and mentoring. Professional indemnity insurane: Member rates on high quality indemnity insurane. Find a Psyhologist: Exlusive listing of APS members in private pratie in an online searhable database for the publi and referrers, regularly attrating over 800 searhes a day. Skilled and effetive advoay: Representation of psyhology and psyhologists to politiians, regulators and workfore planners, as well as the ontribution of psyhologial knowledge for ommunity mental health and wellbeing through proative media ampaigns. APS Advantage: Disounted Qantas Club membership, ompetitive life insurane, redued interest rates on home loans, redit ard redutions, ar hire disounts and more. We enourage you to take part in APS ativities, and welome your feedbak on our range of benefits and servies as well as any issues that are important to you as a psyhologist. For more information on any of these member benefits and servies, go to psyhology.org.au/membership/benefits/ or ontat the APS Member Assistane Centre on (03) or toll free

3 Appliation for eletion as a Member Membership for the subsription year ending 31 May 2016 Who should use this form? NG Use this form if you have ompleted the requirements of an APAC-aredited 5th and 6th year ourse or a researh PhD within the past 12 months from the date you submit your appliation to the APS. There are four payment periods for Members depending on when you lodge your appliation: If you join between 11 February 2015 and 31 May 2015* you pay $ (inl. $27.05 GST) If you join between 1 June 2015 and 31 August 2015 you pay $ (inl. $27.05 GST) If you join between 1 September 2015 and 30 November 2015 you pay $ (inl. $20.28 GST) If you join between 1 Deember 2015 and 10 February 2016 you pay $ (inl. $13.52 GST) * All appliants who join or upgrade during this period pay for a full year and reeive membership until 31 May Attention existing Student Subsribers: Current APS Student Subsribers MUST submit aademi transripts as requested. These are not held on file. PERSONAL DETAILS Dr Mr Mrs Ms Miss Other Family name: Former name (if appliable): Given names: Date of birth: To ensure that we are always able to ontat you, we ask that you supply two addresses. Your preferred mailing address will be reorded as the address to whih all orrespondene will be sent. Your alternate address will be used to ommuniate with you should we have diffiulty ontating you at your preferred mailing address. In addition, your preferred telephone number will be listed in the APS Membership Diretory. *The preferred telephone number will be your general ontat number for release upon request. Preferred mailing address: State: Postode: Alternate address: State: Postode: Preferred telephone*:( ) Alternate telephone: ( ) Preferred fax: ( ) Alternate fax: ( ) Preferred Alternate BASIS FOR APPLICATION 1. I have ompleted four years of aredited study in psyhology AND EITHER a) A two/three year aredited postgraduate oursework degree [Clause 9(a) of the APS Constitution] OR YES b) A postgraduate researh degree (two years full-time minimum) in psyhology [Clause 9(b) of the APS Constitution] YES MEMBERSHIP OF THE APS/ASSESSMENT OF OVERSEAS QUALIFICATIONS Do you hold/have you held any other grade of membership of the Australian Psyhologial Soiety (APS)? (please irle) YES / NO If YES, state grade and membership number (if known): Have you had your overseas qualifiations assessed by the APS in the last 10 years? (please irle) YES / NO If YES, attah opy of assessment letter OR state date when your overseas qualifiations were assessed: 1 Continued on page 2 >

4 ACADEMIC RECORD Please list below all undergraduate and postgraduate qualifiations in psyhology that you have been awarded. Name of institution Qualifiation Month and year ompleted Thesis title (where appliable) IMPORTANT! If you do not submit supporting doumentation in the manner outlined below, the proessing of your appliation will be delayed. Transripts For eah degree, please attah offiial aademi transripts or Australian higher eduation graduation statements that itemise eah subjet undertaken and show ompletion or onferral of eah degree. All pages of a multi-page doument must be submitted and douments must be submitted in either original format or as a ertified photoopy. (Please note: The APS does not aept University letters of ompletion beause they are not onsidered offiial douments). Doumentation submitted to the APS in support of your appliation will not be returned. Current student subsribers MUST submit aademi transripts, as these are not held on file. If your transripts are in another name to that listed on the front of this form, please provide ertified doumentation of your hange of name (for example, Marriage Certifiate or Change of Name Certifiate). Certifiation Photoopies of doumentation must be ertified as true opies of the original by one of the following ertifying offiers: Member of the Soiety (MAPS), aountant, Justie of the Peae, pharmaist, physiotherapist, polie offier, psyhologist. Eah photoopied page should be marked ertified as a true opy of the original and inlude the signature and printed name, profession, registration number and telephone number of the ertifying offier. The ertifying offier must not be a family member or spouse. Researh degrees If you have ompleted a degree solely by researh (for example PhD, Masters), in addition to the offiial aademi transripts, please also provide ertified opies of evidene of your thesis as follows: title page; abstrat; table of ontents; and a list of your supervisors and examiners, indiating their profession and institutional affiliation. Eah page provided must be ertified, as outlined above. Non-Australian degrees If your qualifiations were obtained from outside Australia, please download a opy of the List of Supplementary Questions form from the APS website at psyhology.org.au/membership/applying. This form should be ompleted and submitted with this appliation. NOMINATOR As part of the Member appliation proess, all appliants need to be nominated by a urrent Honorary Fellow, Fellow or Member of the Soiety, who must omplete and sign the Nominator setion below. Only appliants who reside outside Australia are exempt from ompleting this setion of the form. Appliants who are unable to get an Honorary Fellow, Fellow or Member to nominate them should instead supply two reent written referenes about their suitability for eletion to the grade of Member from people who have overseen their work or study. Please download a opy of the Pro-forma for Nomination from the APS website at psyhology.org.au/membership/member or ontat Membership to be sent this pro-forma. I, the undersigned, nominate and believe that she/he meets the requirements of Clause 9, and that to the best of my knowledge, all statements in this appliation are true, and that she/he is a fit and proper person to be eleted to the grade of Member of the Soiety. Full Name: Telephone W: ( ) APS Member Grade: User ID (Membership No): Signature: Date: / / APPLICANT S Delaration YES NO (a) Are you under investigation by the Psyhology Board of Australia (PsyBA) as the result of a notifiation? (b) Have you had an adverse finding made against you by the PsyBA? () Have you been onvited of an offene involving a riminal harge, or is there any harge pending? Note: If you responded YES to any of the above questions, please attah an explanation to this appliation (inluding details of the outome). Mark it IN CONFIDENCE and address it to the Manager Member Servies. In evaluating your appliation, the Manager Member Servies will onsider your response to these questions and may request further information. A positive answer to any of the above questions will not automatially result in rejetion of the membership appliation. Eah appliation will be onsidered on its merits. I hereby delare that: 1. All information submitted by me in this appliation is true to the best of my knowledge. I understand that any misleading statement, or omission, may be ause for rejetion of this appliation. 2. I understand that if my appliation is unsuessful, or if I withdraw or don t omplete my appliation, I may be harged a proessing fee of up to a maximum of $ If eleted as a Member, I will be bound by the Constitution and Code of Ethis and any other rules or regulations adopted by The Australian Psyhologial Soiety Ltd. (Copies of the above douments are available on the APS website, or alternatively from the National Offie of the APS). 4. I understand that my title, full name, preferred ontat telephone number, organisation for whih I work, and membership of APS Colleges will appear in the APS Membership Diretory on the APS website, and that these details may be released by the APS upon request, unless I indiate otherwise by writing to the Manager Member Servies at the APS. 5. I understand that in response to a request from a The Psyhology Board of Australia, the APS may, at its disretion, dislose information held about my qualifiations, experiene and pratie as a psyhologist. Signature: Date: / / 2 Continued on page 3 >

5 REASONS FOR JOINING To assist us to analyse membership trends and statistis, ould you please tik one of the following boxes that best represents your main reason for joining the APS or upgrading your APS membership: Malpratie insurane Aess to APS benefits and servies Required by employer Other (please indiate): To aess the APS website PD and networking opportunities Beoming part of the profession MEMBERSHIP PROFILE Registration Question 1 Do you hold registration with the Psyhology Board of Australia? General Provisional Non-pratising None, not a registered psyhologist Question 2 Do you hold an area of pratie endorsement with the Psyhology Board of Australia? If Yes, Please indiate the area(s) of pratie endorsement below No Clinial neuropsyhology Clinial psyhology Community psyhology Counselling psyhology Eduational and developmental psyhology Forensi psyhology Cultural Bakground The following information will assist us in understanding our membership profile to inform strategi planning and in meeting the needs of members and the profession. Please note that these questions are not mandatory and information will be aessed in aggregate form only.* * These questions have been derived from standard questions used in the Australian Census. The information gathered will be used to generate statistis about the aggregate ultural profile of our membership and will be used to inform strategi planning and for annual reporting. For further information please see the Privay Information setion of this form. Question 1 Are you of Aboriginal or Torres Strait Islander origin? No Yes, Aboriginal** Yes, Torres Strait Islander** Yes, both Aboriginal and Torres Strait Islander** **You may also be interested in beoming a member of the Australian Indigenous Psyhologists Assoiation (AIPA). For further information go to indigenouspsyhology.om.au/ Q In whih ountry were you born? Q In whih ountry was your mother born? Q In whih ountry was your father born? Health psyhology Organisational psyhology Sport and exerise psyhology APS JOURNALS You will reeive six (6) issues of the InPsyh bulletin in hard opy as part of your membership. The APS also produes the Australian Journal of Psyhology (AJP) (4 issues) and the Australian Psyhologist (AP) (6 issues), both of whih are available as online publiations. The APS offers online-only subsriptions for AJP and AP, but members who wish to reeive hard opies an selet to do so below. All members will reeive notifiations when the latest issues of AJP and AP beome available online.* Please indiate in whih format you would like to reeive AJP or AP: Online aess only for AJP and AP $0.00 Hard opy AJP and online AJP and AP $0.00 Hard opy AP and online AJP and AP $0.00 Hard opy AJP and AP and online AJP and AP $95.00 *Members have online aess to all arhived ontent beginning from the very first issue of AJP and AP. PAYMENT 1. If you are paying by heque, please make it payable to: The Australian Psyhologial Soiety Ltd (Australian dollars only please). 2. If you are paying by redit ard, please omplete the following details: Amerian Express Masterard VISA Amount*: $ Card number: Expiry date: / Card holder s name (please print learly): Card holder s Signature: Date: / / A tax invoie/reeipt will be issued following the proessing of your appliation. * The above subsription amount inorporates a proessing fee of $ If your appliation is unsuessful, or if you withdraw or don t omplete your appliation, a proessing fee of up to $ will be harged. (Upgrading Assoiate Members, Affiliates and Student Subsribers whose appliations are unsuessful, withdrawn or inomplete are exempt from this proessing fee.) 3 Continued on page 4 >

6 PRIVACY INFORMATION Proteting Your Privay We are ommitted to proteting your privay, and the onfidentiality and seurity of the personal information held or olleted by the APS. How we use your personal information The personal information provided by you on this appliation form will be used: to assess your eligibility for membership; to update any personal information already held about you on our database; to provide suessful appliants with aess to and information about a range of urrent and future membership benefits; to provide the APS with data and statistis about its membership; to inlude limited information in a publially aessible Membership Diretory, and further information in an APS Members-only aessible version of the Membership Diretory. If you do not provide us with this personal information, we may not be able to proess your appliation. How we ollet personal information In addition to the information olleted from you in this form, the APS may also seek personal information from publily available soures, suh as diretories, or from other soures suh as eduational institutions, the Psyhology Board of Australia or employers, for the purpose of verifying information provided to the APS. When we dislose your personal information We may at times dislose your personal information to organisations external to the APS where those organisations assist us to provide servies to you. Information dislosed to external organisations is done on a limited basis and is provided with the agreement from those servie providers that they will maintain the seurity of that information and use it only for the limited purpose for whih it is dislosed. Auray and Aess The APS strives to keep aurate reords of the personal information we ollet. You have a right to aess your personal information held by the APS, subjet to the exeptions listed in National Privay Priniple 6. If you would like to do so please ontat the Privay Offier as set out below. Your request will need to be put in writing for seurity and reording purposes. Membership Diretory The APS Membership Diretory is not a publially searhable faility. Information inluded in the Diretory may be provided upon request, as follows. For APS members: Your nominated ontat phone number will be released to the publi upon request. (If you do not wish to have your telephone number released to the publi upon request, please write to If you hold one of the membership grades of Assoiate Member, Member, Fellow or Honorary Fellow of the APS, your title, name, ontat phone number, state, organisation for whih you work and APS membership grade will be inluded in the APS Members-only aessible version of the Membership Diretory available through the APS website. If you do not wish to have some or all of these details appear in the Membership Diretory, please write to If you hold one of the membership grades of Member, Fellow or Honorary Fellow of the APS, your membership of APS Colleges will be inluded in the APS Members-only aessible version of the Membership Diretory available through the APS website. If you do not wish to have your College membership appear in the Membership Diretory, please write to In response to a request from the Psyhology Board of Australia, the APS may, at its disretion, dislose information held about your qualifiations, experiene and pratie as a psyhologist. The APS may seek your onsent to have the same details as those inluded in the Membership Diretory made aessible to other allied health organizations for the purpose of inreasing aess by appropriately qualified professionals to psyhologists for the purpose of making referrals. Our Privay Poliy For further information about the APS s privay poliy, refer to the APS website at psyhology.org.au. Copies of the APS Privay Poliy may be downloaded from the website. HAVE YOU...? 1. Enlosed your originally ertified aademi transript(s) showing individual subjets and proof of ompletion/onferral of eah award? Had your form signed by a Nominator? Completed the form and signed the Delaration setion? Attahed your payment?... SEND FORM TO... One you have ompleted this form, please send it together with your ertified aademi transripts and relevant subsription payment to: Membership The Australian Psyhologial Soiety Ltd PO Box 38, Flinders Lane VIC 8009, AUSTRALIA Telephone enquiries to Membership on or toll free enquiries to 15APS-M-E-F-MNG-P2 4

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