APC renewal form 2017/2018

This form is to be used only by psychotherapists who have

completed the online section of the APC renewal process.

Renewal Notice for Annual Practising Certificates 2017/2018

  1. Declaration for an Annual Practising Certificate

I wish to apply for an Annual Practising Certificate (APC) for the practising year 1 October 2017 – 30 September 2018.

  • I am currently practising psychotherapy;
  • I believe I am competent to practise within my scope of practice;
  • I am engaged in the Board’s recertification programme which involves completing the Board’s Recertification Plan template and discussing it with my supervisor. I will participate in an audit should my name be selected.(For further information please see the recertification and audit page on the Board’s website).
  • I have already made the correct APC fee payment online or have enclosed the correct fee with this application (page 2).

Applicant’s Name:Registration Number:

Date:Applicant’s Signature:

  1. Supervisor Attestation

I am a registered psychotherapist with a current APC; or

I am registered under the HPCAA with a current APC and have been approvedby the Board as having suitable psychotherapy training, knowledge, skill and/or professional development.

(If you have not previously been approved, please see the ‘supervisors’ section on the Board’s website).

  • I have sighted and discussed my supervisee’s areas for growth, development and/or improvement (their Recertification Plan);
  • I am satisfied to the best of my knowledge, that the continuing professional development activities my supervisee has outlined are appropriate for maintaining competence in his/her scope, practice area, and level of experience;
  • I can confirm that my supervisee has attended and participated in regular supervision and that to the best of my knowledge he/she understands and adheres to the Board’s Core Clinical Competencies, Cultural Competencies and Ethical Standards.

Comments:

Supervisor’s name:

Supervisor’s Signature:

  1. APC Payment[1]

I have already made a payment online: Credit card Date:

Direct credit Date:

Payment form for those who have not already paid online

I am paying by: Visa MasterCard

Credit card number:

Expiry date:

Name on card:

Practitioner Name (if different from above):

Card CVS Number:

Cardholder’s signature:Date:

I enclose payment for (tick one):

APC fee $850.00

Applies only to complete[2] applications received by or before midnight 1 October 2017

APC fee $1050.00

Applies to all applications received on or after 2 October 2017

Reduced APC fee$500.00

Applies only to complete applications received by or before midnight1 October 2017

All fees include GST

Page 1 of 2

Completed APC renewal forms should be returned to:
Psychotherapists Board of Aotearoa New Zealand,

PO Box 9644, Wellington 6141

APC renewal form 2017/2018

Health Practitioner Competence Assurance Act 2003 Information

The principal purpose of the Health Practitioners Competence Assurance Act 2003 (HPCAA) is to ‘protect the health and safety of members of the public by providing for mechanisms that ensure health practitioners are competent and fit to practise their professions’. You are applying for an APC under the HPCAA – Section 26(i).

Section 7(2) of the HPCAA states that ‘no person may claim to be practising a profession as a health practitioner of a particular kind or state or do anything that is calculated to suggest that the person practises or is willing to practise a profession as a health practitioner unless the person:

- is a health practitioner of that kind; and

- holds a current practising certificate as a health practitioner of that kind.

Annual Practising Certification (APC) Information

You must hold an APC if you intend to practise as a psychotherapist in New Zealand for all or part of a year. It is your responsibility to make sure that you hold a current APC. This responsibility cannot be passed onto an employer.

If this application form and fee payment are not received by the Psychotherapists Board of Aotearoa New Zealand (the Board) before midnight on or before 1 October 2017, you will have no legal entitlement to practise as a psychotherapist on 2 October 2017 or on any subsequent day until the date that a new practising certificate is issued to you. Renewing your APC late (letting it lapse) puts at risk your lawful practice as a psychotherapist.

APCs are valid for the current practising year in which they are issued, and are non-refundable.

Note: If you are renewing an APC, provided you have not let your APC lapse, you will be treated as the holder of your new APC from the date the Board receives your completed application, including payment, until the date it is issued or you are notified that it will not be issued. If your completed APC renewal form and payment is not with the Board before midnight 1 October 2017, your APC will have lapsed. APCs are not backdated.

IMPORTANT INFORMATION FOR PRACTISING CERTIFICATE APPLICANTS

The Board will consider whether an application for an APC should be declined, or if conditions should be included on the APC, where the Registrar believes on reasonable grounds that:

  • the applicant has failed to fulfil or has failed to comply with a condition included in their scope of practice; or
  • the applicant has not held an APC of a kind sought by the applicant within the 3 years immediately preceding the date of the application; or
  • the applicant is unable to perform the functions required for the profession because of a mental or physical impairment; or
  • the applicant has not, within the 3 years immediately preceding the date of application, lawfully practised the profession to which the application relates; or
  • any information included in the application is false or misleading.

Privacy Act Information

The information in this form will be used for the purpose of performing the Board’s functions under the HPCAA. Under the Privacy Act 1993, the applicant has the right to access to, and correction of, personal information held by the Board. No individual’s information will be disclosed to any other person(s) or organisation(s) without the permission of the applicant unless required by law.

Information Page

[1]APCs are valid for the current practising year in which they are issuedand are non-refundable

[2] A complete applicationincludes the renewal form (signed) and the payment.