Accredited Clinical Membership

Part A: Personal Details

Title:

First Name:

Surname:

Date Of Application:

Email:

Telephone:

Full Address (including postcode):

Training

Part B : Clinical Practice Declarations

Are you currently in clinical practice ? :

If NO please list any breaks in practice over 3 months in the additional comments section below

Yes No

CLIENT HOURS PER WEEK:

CLINICAL PRACTICE ADDRESS:

SUPERVISION HOURS PER MONTH : (From 01.10.2022 the minimum supervision requirement post accreditation is 1.5 hours per month. Prior to accreditation the 1:6 ratio remains. Post accreditation peer or group supervision hours also count as equivalent to individual supervision.)

PERSONAL THERAPY :

Clinical Supervisor(s) Details

(Please provide details of all supervisory arrangements)

NAME:

ADDRESS:

TELEPHONE:

EMAIL:

REGISTRATION:

START DATE:

Clinical Practice Declaration :

Have any complaints been made against you regarding your clinical work:

Yes No

INDEMNITY INSURANCE

Members are required to hold full clinical indemnity insurance:

NAME OF INSURER:

DATE INSURED FROM:

DATE INSURED TO:

*Please upload a copy of your Indemnity Insurance certificate, board minutes or a copy of your certificate of qualification*

Terms and Conditions

ACCREDITED CLINICAL MEMBERSHIP:

I agree to:

Maintain sufficient clinical practice hours
(recommended guideline, normally 4 client hours per week)
Maintain regular clinical supervision (From 01.10.2022 the minimum supervision requirement post accreditation is 1.5 hours per month. Prior to accreditation the 1:6 ratio remains). Post accreditation peer or group supervision hours also count as equivalent to individual supervision
Work in accordance with the UKCP Code of Ethics and Professional Practice
Advise UPCA of any breaks in practice longer than 3 months
Advise UPCA of any complaints or convictions made against you
Maintain adequate professional indemnity insurance
If selected, you will be required to submit your CPD documentation for audit.
You will be selected for audit once in every five years
Maintain a minimum of 50 hours annual CPD to ensure safe practice
Comply by the UPCA Fitness to Practice procedures
Notifying UPCA if my contact details change

DECLARATION:

I declare that my application form contains only true information. I understand that UPCA may make enquiries as they consider necessary to verify any information given. I understand that if any incorrect, incomplete or plagiarised information is discovered, my application/renewal may be invalid and UPCA has the right to withdraw my application. I understand that my UKCP Registration is dependent upon my remaining membership of UPCA.

MEMBER SIGNATURE / E-SIGNATURE

DATE

Section E

Once you’ve submitted your application form, we’ll contact your university to confirm your eligibility and ask your course leader to validate your application. This helps us ensure that all applicants meet the necessary criteria and are supported by their academic institution.

PLEASE NOTE-IF YOU ARE ALSO MAKING AN APPLICATION TO JOIN UKCP: Accredited Clinical Members of UPCA who wish to become UKCP registered, must make a separate online application to UKCP at; www.psychotherapy.org.uk/join-us/

This cannot be done on your behalf by UPCA or your training university. Once UKCP receives your completed application form and payment information, they will verify your current membership of UPCA. This will usually take around 7-10 working days.

UKCP membership and fees are additional to, and separate from UPCA membership fees, UKCP will also send you a reminder every August for membership year 1st October to 30th September.

UKCP MEMBERSHIP IS DEPENDANT UPON YOU CONTINUALLY MAINTAINING YOUR UPCA MEMBERSHIP.

Data Protection

The information you provide in this form is required to process your membership. You will have the right to access the information you have provided as well as the other rights afforded to you under data protection laws. You may request for the information to be destroyed. This will result in your withdrawal from the process. If you do not provide all the information required on this form your renewal may not be processed.

Information submitted may be stored and processed electronically for the purposes of delivering services, marketing and supplying information. Data may be passed to other parts of the organisation and partner organisations operating on our behalf to enable this to take place. We will ensure your data is always stored and handled securely.

To find out more about the way we look after personal data please see the UPCA privacy notice on our website at: www.upca.org.uk

💰 Choose Your Payment Method

If you choose to pay by Stripe, you’ll be asked to securely enter your card details directly on the form. Your payment will be processed immediately, and you’ll receive confirmation by email once it's complete.

By submitting your payment, you agree to our Terms and Conditions and Privacy Policy.

If you prefer to pay by bank transfer, please make your payment as soon as possible after submitting your form, as we cannot process your application or renewal until payment is received.

For UK payments, transfer to:

Account Title UPCA
Account Number 40241253
Sort Code 20-35-27

For international payments in GBP £:

SWIFTBIC BUKBGB22
IBAN GB05 BUKB 2035 2740 2412 53

Please email your payment receipt to administration@upca.org.uk after payment to expedite processing.