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Copyright of IACAT. All rights reserved.
MEMBERSHIP APPLICATION
Choose Discipline Of Your Application *
- choose -
Art Therapy
Dance Movement Therapy
Dramatherapy
Music Therapy
Expressive Arts Therapy
Select Membership Type *
- choose -
Professional Membership - €110 p.a.
Associate Membership - €60 p.a.
Non Practising Membership - €50 p.a.
Student Membership - €50 p.a.
Organisational Membership - €100 p.a.
PERSONAL DETAILS
First Name *
Surname *
Personal Email *
Personal Phone *
Organization name *
Addr (Line1) *
Addr (Line2)
City/Town/Village *
County *
Postcode
Country
Ireland
UK
Are you applying from an over seas college?
YES
NO
MEMBERSHIP DATA
Name of National Professional Association:
Full title of course as named by the degree awarding authority:
Degree & Grade obtained:
Date of commencement & completion:
Name & Address of University, institute, college or other degree awarding authority:
Contact details of course director (name, telephone, email):
Course content transcript details required
please upload
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Supervised clinical placement including hours completed
please provide dates and names of placements and supervisors with their qualifications and signatures. Please upload letter from supervisor(s)
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Personal therapy hours undertaken during and/or after course qualification
Please provide dates and names of therapists with their qualifications and signatures.
Please upload letter from therapist(s) confirming hours completed *
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Therapeutic group work (group process) hours undertaken.
please upload letter from group process therapist(s) *
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Experiential components of training
please provide course descriptions
Theoretical components: Module titles & hours completed
please provide course descriptions
Continual Professional Development
unless qualified less than two years before applying to IACAT for registration, please provide details of CPD since qualification/ graduation.
MEMBERSHIP DATA
Title of your Masters/Course of Study *
College / University *
Upload Your Masters Certificate
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Are you a supervisor?
Title of Supervisor Course
College / University
Upload Your Completion Certificate
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Add to IACAT Supervisor Register
Other Professional Memberships
Current or Previous Statutory Registrations / Memberships . e.g. CORU, HCPC
PUBLIC REGISTER
Add to IACAT Website Therapist Register
Specialises in
ABI and Rehab
Autistic Spectrum Disorders
Bereavement
Communication disorders
Corporate
CPD / workshops
Dementia
Early intervention
Emotional & behavioural disorders
Forensic services
Intellectual disability
Medical conditions
Mental health
Palliative care
Personal development
Physical disabilities
Sensory impairments
Substance misuse
Locations/Counties you service
Practice Address
Practice Phone
Practice Email
Practice Website
Brief Bio
Sessional work
Private Referrals
EMPLOYMENT/SKILLS PROFILE
HSE Employee (PAYE)
Private Practice
Children/Adolescence
Adults
Groups
Family
Please Upload Your Insurance Certificate
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Educational Services
Primary
Secondary
Third level
Gov Health Services
Adults
Child/Adolescence
Residential Care
Hospitals
Clinics/GPs
Elderly Care
Palliative Care
ABI
Other
Forensic Services
Prisons
Probation
Addiction Services
Alcohol/Substance
Gambling
Other
Disability Services
Physical
Intellectual
Learning
Other
Voluntary
Charities
Social Enterprises
Other
Have You Ever Had A Complaint In Your Proffesional Pracice
YES
NO
What was the name of the organisation who dealt with the complaint?
I accept IACAT
Code of Ethics
of membership
