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PERSONAL DETAILS First Name * Surname * Personal Email * Personal Phone * Organization name * Addr (Line1) * Addr (Line2) City/Town/Village * County * Postcode Country

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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 requiredplease upload Choose File Supervised clinical placement including hours completedplease provide dates and names of placements and supervisors with their qualifications and signatures. Please upload letter from supervisor(s) Choose File Personal therapy hours undertaken during and/or after course qualificationPlease provide dates and names of therapists with their qualifications and signatures.
Please upload letter from therapist(s) confirming hours completed * Choose File Therapeutic group work (group process) hours undertaken. please upload letter from group process therapist(s) * Choose File Experiential components of trainingplease provide course descriptions Theoretical components: Module titles & hours completedplease provide course descriptions Continual Professional Developmentunless qualified less than two years before applying to IACAT for registration, please provide details of CPD since qualification/ graduation.

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