Associate, Student and Retired Categories
Please note that an Affiliate membership in NSCCT does not qualify you as a Registered Counselling Therapist, and mention of membership is not to be utilized on any advertising or identification materials such as business cards, letterhead, signatures, in resumes, or in any other way intended to be construed as a credential. Should you wish to use a qualification designation from NSCCT, you must first apply to become a Registered Counselling Therapist-Candidate. See NSCCT Membership section for details.
Return competed form to: NSCCT, PO Box 54, Kentville, NS B4N 3V9
CONTACT INFORMATION: Please Print
LAST NAME: ______FEMALE:___ MALE:___
FIRST NAME: ______TELEPHONE: (daytime)______
ADDRESS: ______(evening) ______
COMMUNITY:______PROVINCE: ______POSTAL CODE:______
EMAIL: ______
EDUCATION: INSTITUTION:______HIGHEST DEGREE (to date): ______
MONTH/YR OF GRADUATIION: _____/______SPECIALIZATION: ______
AFFILIATE MEMBERSHIP CATEGORIES AND FEES:
Category / Documentation to include / Choose prorated fee on back of formAssociate / Current Resume is to be enclosed with membership application / $
Student / Letter from post-secondary institution verifying student’s current enrolment in a Masters level ‘counselling therapy education program’ is required. / $
Retired / Only available to retiring Registered Counselling Therapist members:please insert RCT #______ / $
Fee Enclosed: $ ______ based on my membership starting: Month ______Year _____
____cheque ____ money order made payable to the ‘Nova Scotia College of Counselling Therapists’
______
DECLARATION –Kindly answer all questions by checking the ‘yes’ or ‘no’ box next to each one. Then sign the space below which will confirm the responses you have made. Unsigned applications will not be processed.
Have you ever:
(1)been convicted or charged with a criminal offence ? (If so, provide details)(2)had a finding of or are you facing a proceeding of professional misconduct, incapacity, or incompetency filed against you in Nova Scotia or another jurisdiction? (If so, provide details)
(3)been registered to practice as a Counselling Therapist in other provinces or countries? (If so, provide copy of registration / membership card.)
By becoming a member of the Nova Scotia College of Counselling Therapists (NSCCT), I agree that NSCCT is authorized to collect, utilize and disclose personal information regarding my status within NSCCT and any other information required to comply with NSCCT’s mission of protecting the public. As a member of the NSCCT, I hereby pledge to uphold the Canadian Counselling and Psychotherapy Association’s Code of Ethics and Standards of Practice at all times.
Signature: ______Date: ______/ Yes
Yes
Yes
/ No
No
No
INSTRUCTIONS FOR COMPLETION OF THIS MEMBERSHIP APPLICATION
FEES: NSCCT memberships are being provided on a pro-rated basis until the next renewal date for all members – April 1, 2015. The yearly rate cannot be used, but is provided to show what the pro-rated fees are based on. There is no need to send along this page with your member- ship application. Use it to determine the appropriate fee for your membership category based on the month your membership will be processed (the month after you send in your form).
All membership fees are calculated based on the first day of each month. (For example: If your form and accompanying documents are received on May 21st , your membership will be processed for June 1st. Hence your cheque or money order should be chosen from the June 1, 2014 row.)
DOCUMENTATION: Please remember to arrange for any documentation required for your membership to be processed. This must be sent directly from the issuing institutionto NSCCT, PO Box 54, Kentville, NS B4N 3V9. Associate members must supply a current resume.
Affiliate Membership Categories and FeesMonth Renewing Membership / Membership Valid Until / Associate,
(based on $100.00/year) / Retired or Student (based on $50.00/year)
April 1, 2014 / March 31, 2015 / $100.00 / $ 50.00
May 1, 2014 / March 31, 2015 / $ 91.46 / $ 45.90
June 1, 2014 / March 31, 2015 / $ 82.99 / $ 41.65
July 1, 2014 / March 31, 2015 / $ 74.80 / $ 37.54
August 1, 2014 / March 31, 2015 / $ 66.34 / $ 33.29
September 1, 2014 / March 31, 2015 / $ 57.88 / $ 29.04
October 1, 2014 / March 31, 2015 / $ 49.69 / $ 24.93
November 1, 2014 / March 31, 2015 / $ 41.22 / $ 20.69
December 1, 2014 / March 31, 2015 / $ 33.03 / $16.58
January 1, 2015 / March 31, 2015 / $ 24.57 / $12.33
*February 1, 2015 / March 31, 2015 / $16.11 / $ 8.08
*March 1, 2015 / March 31, 2015 / $ 8.46 / $ 4.25
* Please Note: If you wish to start a new membership with NSCCT in either February or March, 2015,
please contact the NSCCT office to make arrangements for your yearly renewal at the same time.