General Membership Handbook

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1 General Membership Handbook Revised: December 22, 2010

2 Table of Contents 1. Membership as a Research Scientist A. Membership Requirements B. Eligibility C. Application Process D. Fees E. Renewal Process F. Notification 2. Membership as a Professional Colleague A. Membership Requirements B. Eligibility C. Application Process D. Fees E. Renewal Process F. Notification 3. Membership as a Student Affiliate A. Membership Requirements B. Eligibility C. Application Process D. Fees E. Renewal Process F. Notification 4. Confidentiality Policy 5. Disciplinary Policy 6. Procedures for ADA Compliance 7. Nondiscrimination Appendixes A. Research Scientist Application B. Professional Colleague Application C. Student Affiliate Application D. Fee Schedule General Membership Handbook 1

3 This General Membership Handbook was created to inform potential Academy of Cognitive Therapy (ACT) applicants of the current standards, policies and practices related to ACT Research Scientist, Professional Colleague and Student Affiliate membership. ACT reserves the right to revise this General Membership Handbook and the policies contained herein as deemed appropriate. To ensure that you have the most current version of this handbook, please refer to the ACT website or contact the ACT Administrative Office. 1. Membership as a Research Scientist A. Membership Requirements ACT Research Scientist membership is suitable for cognitive behavioral therapy researchers who support the use of cognitive behavioral therapy to treat mental health disorders and improve health behaviors, and who are dedicated to increased access to evidence-based, cost-effective models of care. Research Scientists have not been certified by ACT and cannot represent themselves as Certified. B. Eligibility To join ACT as a Research Scientist, you must be a professional within the field of mental health currently conducting research related to Cognitive Behavioral Therapy and hold a terminal degree in your respective field of expertise. C. Application Process In addition to providing evidence to support your eligibility, you must submit your current curriculum vitae, three representative publications in which you have held the title of the Principal Investigator or Senior Author OR three PubMed citations or citation links, and pay the prescribed fees. General Membership Handbook 2

4 D. Fees Yearly membership for a research scientist is $50. Initial application requires a one time fee of $15 in addition to the yearly membership fee. If an individual joins after September 1 st, his or her membership will not expire until December 31 st of the following year. Applications will not be processed until payment has been made. *Upon application individuals are required to pay the application fee and the membership fee for the first year. E. Renewal Process The designation of Research Scientist is renewable each year with payment of fees. F. Notification The Academy of Cognitive Therapy Committee will notify the applicant of the result of his/her application submission following payment and the submission of all required documents. 2. Membership as a Professional Colleague A. Membership Requirements ACT Professional Colleague membership is suitable for professionals who support the use of cognitive behavioral therapy to treat mental health disorders and improve health behaviors, and who are dedicated to increased access to evidence-based, cost-effective models of care, and who work in the field of mental health, public health or health care. Professional Colleagues have not been certified by ACT and cannot represent themselves as Certified. B. Eligibility To join ACT as a Professional Colleague, you must hold an advanced degree and be a health care professional in psychology, social work, nursing, medicine, General Membership Handbook 3

5 public health, marital and family therapy, education, pastoral counseling, or a related field. C. Application Process In addition to providing evidence to support your eligibility, you must submit your current curriculum vitae. D. Fees Yearly membership for a Professional Colleague is $65. Initial application requires a one time fee of $15 in addition to the yearly membership fee. If an individual joins after September 1 st, his or her membership will not expire until December 31 st of the following year. Applications will not be processed until payment has been made. *Upon application individuals are required to pay the application fee and the membership fee for the first year. E. Renewal Process The designation of Professional Colleague is renewable each year with payment of fees. F. Notification The Academy of Cognitive Therapy Committee will notify the applicant of the result of his/her application submission following payment and the submission of all required documents. 3. Membership as a Student Affiliate A. Membership Requirements ACT Student Affiliate membership is suitable for students and residents who support the use of cognitive behavioral therapy to treat mental health disorders and improve health behaviors and who are dedicated to increased access to evidence-based, cost-effective models of care. Student Affiliates have not been certified by ACT and cannot represent themselves as Certified. General Membership Handbook 4

6 B. Eligibility To join ACT as a Student Affiliate, you must be a student in a professional program or enrolled in an internship, residency, or post-graduate training program in a mental health or health discipline. You must verify your status as a student by submitting a copy of your current college or university ID. C. Application Process In addition to providing evidence to support your eligibility, you must provide evidence of being a student in good standing in a professional program, submit two professional reference forms from a professional in your field who is familiar with your work, and pay the prescribed fees. D. Fees Yearly membership for a Student Affiliate is $25. Students are not required to pay an application fee. If an individual joins after September 1 st, his or her membership will not expire until December 31 st of the following year. Applications will not be processed until payment has been made. E. Renewal Process The designation of Student Affiliate is renewable each year with payment of fees. F. Notification The Academy of Cognitive Therapy Committee will notify the applicant of the result of his/her application submission following payment and the submission of all required documents. 4. Confidentiality Policy It is ACT s policy to keep confidential all information relating to the personal information of ACT applicants and consumers; specific applicant submission; and contact information of applicants (unless expressly deemed public information by the applicant). General Membership Handbook 5

7 5. Disciplinary Policy ACT retains the right to deny or revoke eligibility or membership of any applicant or member of ACT according to the provisions put forth in ACT s disciplinary policy, which includes but is not limited to any application to ACT that includes falsified or fraudulent credentials or materials or is predicated upon deceptive means. The complete Disciplinary Policy is available upon request. 6. Procedures for ADA Compliance Our application process does not require applicants to come to the ACT Administrative Office to apply. Applicants may complete their application in the privacy of their own homes or offices. Requests for application accommodations therefore do not apply. ACT is fully compliant with the Americans with Disabilities Act. 7. Nondiscrimination It is the Corporation s fundamental policy that discrimination on the basis of race, color, religion, national origin, ancestry, sex, disability, sexual orientation, or age is strictly prohibited in the terms, conditions and privileges of employment and affiliation in the Corporation, and in the administration, and implementation and utilization of programs and services. General Membership Handbook 6

8 General Membership Handbook 7

9 Appendix A Application for Research Scientist

10 SM Application for Certification as a Research Scientist Please submit this application with: A copy of your curriculum vitae Three representative publications related to the field of cognitive behavioral therapy for which you are the principal investigator or senior author OR three PubMed citations Payment: application fee and membership fee For official use only: Payment Publications C.V. Date: CONTACT INFORMATION (Please type or print clearly): First: Middle: Last: Date of birth: Current title or affiliation: Mailing Address Street Suite City State Zip Phone Fax Country Business Address Same as mailing Street Suite City State Zip Phone Fax Country How did you hear about ACT? ACT Member (Certified Affiliate or Founding Fellow) Cognitive Therapy Training, Education or Research Organization College or University Conference Other Please specify organization, individual, etc: Research Scientist Application 1

11 DEMOGRAPHIC INFORMATION (Optional): While it is optional to report your gender, race and ethnicity during the application process, the Academy of Cognitive Therapy encourages all applicants to do so. This demographic data plays a critical role in supporting grant applications to provide foundations and government agencies, the majority of which will not fund an organization without this data. Gender: Female Male Transgender U.S. Residents Ethnicity (select one): Hispanic or Latino Not Hispanic or Latino International Applicants International Resident Race/Ethnicity: Race (select one or more): American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White PROFESSIONAL DEGREE Please check the box that indicates your professional degree. M.D. Ph.D. Psy.D. Ed.D. D.S.W. M.S.W L.C.S.W. M.A. M.S. M.S.N A.P.N. O.T.R. Other (please specify): Please indicate the Major Field in which you received your degree (i.e., counseling, psychiatric nursing, family practice, clinical psychology, etc.): Institution granting the degree: Department: Date of the degree (mm/dd/yyyy): Mailing address of institution: Street Suite City State Zip Phone Fax Country LICENSE Do you currently hold or are you working toward a license for clinical practice? Yes No Research Scientist Application 2

12 CURRICULUM VITAE I have enclosed a copy of my Curriculum Vitae I will submit my Curriculum Vitae via: Mail Fax REPRESENTATIVE PUBLICATIONS I have enclosed a copy of three representative publications or PubMed citations I will submit copies of three representative publications via: Mail Fax PAYMENT I have enclosed a check for $65.00 made payable to the Academy of Cognitive Therapy. I wish to pay by credit card. My account information is as follows: Credit card payment: VISA MC # exp 260 South Broad Street 18 th Floor Philadelphia, PA Phone: Fax: Web site: Research Scientist Application 3

13 Appendix B Application for Professional Colleague Fee Schedule 1

14 SM Application for Certification as a Professional Colleague Please submit the following with this application: A copy of your curriculum vitae Two professional reference forms Payment: application fee and membership fee For official use only: Payment C.V. Professional Reference Forms Date: CONTACT INFORMATION (Please type or print clearly): First: Middle: Last: Date of birth: Current title or affiliation: Mailing Address Street Suite City State Zip Phone Fax Country Business Address Same as mailing Street Suite City State Zip Phone Fax Country Research Scientist Application 1

15 How did you hear about ACT? ACT Member (Certified Affiliate or Founding Fellow) Cognitive Therapy Training, Education or Research Organization College or University Conference Other Please specify organization, individual, etc: DEMOGRAPHIC INFORMATION (Optional): While it is optional to report your race and ethnicity during the application process, the Academy of Cognitive Therapy encourages all applicants to do so. This demographic data plays a critical role in supporting grant applications to provide foundations and government agencies, the majority of which will not fund an organization without this data. Gender: Female Male Transgender U.S. Residents Ethnicity (select one): Hispanic Or Latino Not Hispanic or Latino International Applicants International Resident Race/Ethnicity: Race (select one or more): American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White PROFESSIONAL DEGREE Please check the box that indicates your professional degree. M.D. Ph.D. Psy.D. Ed.D. D.S.W. M.S.W L.C.S.W. M.A. M.S. M.S.N A.P.N. O.T.R. Other (please specify): Please indicate the Major Field in which you received your degree (i.e., counseling, psychiatric nursing, family practice, clinical psychology, etc.): Institution granting the degree: Department: Date of the degree (mm/dd/yyyy): Mailing address of institution: Street Suite City State Zip Phone Fax Country Research Scientist Application 2

16 LICENSE Do you currently hold or are you working toward a license for clinical practice? Yes No CURRICULUM VITAE I have enclosed a copy of my Curriculum Vitae I will submit my Curriculum Vitae via: Mail Fax PAYMENT I have enclosed a check for $80.00 made payable to the Academy of Cognitive Therapy. I wish to pay by credit card. My account information is as follows: Credit card payment: VISA MC # exp 260 South Broad Street 18 th Floor Philadelphia, PA Phone: Fax: Web site: Research Scientist Application 3

17 Appendix C Application for Student Affiliate Research Scientist Application 4

18 SM Application for Certification as a Student Affiliate Please submit the following with this application: Proof of enrollment Two professional reference forms Payment: membership fee For official use only: Payment Professional Reference Forms Date: CONTACT INFORMATION (Please type or print clearly): First: Middle: Last: Date of birth: Current title or affiliation: Mailing Address Street Suite City State Zip Phone Fax Country Business Address same as mailing Street Suite City State Zip Phone Fax Country Research Scientist Application 5

19 How did you hear about ACT? ACT Member (Certified Affiliate or Founding Fellow) Cognitive Therapy Training, Education or Research Organization College or University Conference Other Please specify organization, individual, etc: DEMOGRAPHIC INFORMATION (Optional): While it is optional to report your race and ethnicity during the application process, the Academy of Cognitive Therapy encourages all applicants to do so. This demographic data plays a critical role in supporting grant applications to provide foundations and government agencies, the majority of which will not fund an organization without this data. Gender: Female Male Transgender U.S. Residents Ethnicity (select one): Hispanic Or Latino Not Hispanic or Latino International Applicants International Resident Race/Ethnicity: Race (select one or more): American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White CURRENT ENROLLMENT Graduate School Check the box indicating the degree toward which you are working M.D. Ph.D. Psy.D. Ed.D. D.S.W. M.S.W L.C.S.W. M.A. M.S. M.S.N A.P.N. O.T.R. Other (please specify): Please indicate the Major Field in which you received your degree (i.e., counseling, psychiatric nursing, family practice, clinical psychology, etc.): Student Status Verification You must verify your status as a student by submitting a copy of your current college or university ID. You can submit a copy via fax ( ), a digital attachment sent to or by mail. Research Scientist Application 6

20 Post Graduate Training Program Residency Post-Doctoral Fellow OTHER (please specify): Please indicate the Major Field associated with this training program (i.e., clinical psychology, counseling, education, etc.): Institution granting the degree: Department: Expected date of degree (mm/dd/yyyy): Mailing address of institution: Street Suite City State Zip Phone Fax Country PAYMENT I have enclosed a check for $25.00 made payable to the Academy of Cognitive Therapy. I wish to pay by credit card. My account information is as follows. Credit card payment: VISA MC # exp 260 South Broad Street 18 th Floor Philadelphia, PA Phone: Fax: Web site: Research Scientist Application 7

21 Research Scientist Application 8

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