Download PART 5: Continuing Professional Development (CPD)

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Register Reactivation Form
PART 1: Personal Details
Your personal details will be treated as private and confidential
Family Name:
Title:
Given Names:
Register No:
Postal address:
Suburb:
Telephone:
(
)
State:
Postcode:
Mobile:
Email:
Name of PACFA
Member Association:
* Please enclose proof of current membership
PART 2: Published Details
All PACFA Registrants are listed on the PACFA website. Please specify any changes to your website listing:
Name:
New qualifications:
(evidence required)
Practice Address 1:
Suburb:
State:
Postcode:
Suburb:
State:
Postcode:
Suburb:
State:
Postcode:
Practice Address 2:
Practice Address 3:
Practice Telephone:
(
)
Practice Mobile:
Practice Email:
Practice Website:
PART 3: Professional Indemnity Insurance
Please attach a certificate of currency for your Professional Indemnity Insurance. Your Professional Indemnity
must cover the totality of your work as a Psychotherapist or Counsellor.
Practitioners who are not in private practice need to provide a letter from their employer stating that they
are covered by their employer’s professional indemnity policy to practice as a therapist.
Updated 30/6/2016
PART 4: Professional Supervision
The date you reactivate your registration determines the amount of Supervision to be completed.


If you reactive on 30 June and request your registration to be reactivated on 1 July, you only need to
provide evidence of your completed Supervision in the previous 12 months.
If you wish to reactivate immediately and not wait until 1 July, there are additional requirements to
be met. You would need to complete 12 months of supervision at the time of reactivation PLUS an
additional year of supervision at renewal time (30 June).
Supervision – Applicants are required to have completed 10 hours of clinical supervision in the 12 months
immediately prior to reactivation. If applicants accrued over 400 client practice hours in the 12 months
immediately prior to reactivation, 15 hours of supervision will be required. A further 10 (or 15) hours of
supervision must be completed before the next annual renewal date (30 June) if you do not wait until 1 July
to reactivate.
Supervision may, for the purpose of this application, take the form of individual or small group meetings (a
maximum of six supervisees and a supervisor). It is not the same as administrative or management
supervision, nor is it the same as psychotherapy or counselling of the supervisee. PACFA does not accept
supervision in dual relationship situations.
Peer supervision – Applicants can claim a maximum of 50% peer supervision only if they have been Clinical
Registrants with PACFA continuously for at least 5 years. Where the Registrant has not been listed on the
PACFA Register for 5 years, evidence of prior eligibility for clinical registration AND the 5 years supervised
practice would need to be provided in order to be eligible to claim Peer Supervision. Peer supervision is a
formal process where therapists contract to provide collegial critiquing and enhancement of each other’s
clinical client work. Colleagues or peers work together for mutual benefit, rotating the roles of supervisor
and supervisee. Peer supervision can be undertaken as a dyad or within a small group of no more than 6
members. Please note: PACFA does not accept supervision by relatives or partners.
To be completed by the applicant’s supervisor:
Supervisor’s name:
Supervisor’s
address:
Supervisor’s
phone:
Suburb:
(
)
State:
Postcode:
Email:
Supervisor’s
Qualifications:
Supervision was:
Individual
Session duration (minutes):
No of sessions:
Group
(max. 12
people)
Session duration (minutes):
No of sessions:
Session duration (minutes):
Number in Group:
This report relates to the period:
/
/
to
/
/
Total supervision hours
completed:
Supervisor’s signature:
Date:
/
/
Total supervised client
contact:
Applicant’s signature:
Date:
/
/
* Please complete additional tables if you have more than one supervisor. Copy this page if required.
Updated 30/6/2016
PART 5: Continuing Professional Development (CPD)
The date you reactivate your registration determines the amount of CPD to be completed.


If you reactive on 30 June and request your registration to be reactivated on 1 July, you only need to
provide evidence of your completed CPD in the previous 12 months.
If you wish to reactivate immediately and not wait until 1 July, there are additional requirements to
be met. You would need to complete 12 months of supervision at the time of reactivation PLUS an
additional year of CPD at renewal time (30 June).
Applicants are required to have completed 40 points of CPD in the 12 months immediately prior to
reactivation. A further 40 points of CPD must be completed before the next annual renewal date (30 June) if
you do not wait until 1 July to reactivate. CPD supports practitioners to keep up to date with new
developments in practice. CPD must be relevant to ongoing clinical practice and to the core competencies of
psychotherapy and counselling practice.
Annual CPD requirement – 40 points
There are 3 categories from which the 40 CPD points may be accrued:
Category A - MANDATORY: One hour of CPD = 2 points. Minimum annual requirement – 30 points
Category B - OPTIONAL: One hour of CPD = 1 point. Maximum annual allowance – 10 points
Category C- OPTIONAL: One hour of CPD = 1 point. Maximum annual allowance – 5 points
The 40 CPD points may all be accrued from category A if preferred as Categories B and C are optional.
CATEGORY A
A minimum requirement of 30 points per year via:
 Person-to-person courses, workshops, seminars and conferences.
 Participation in online facilitated courses
At least 10 points must be person-to-person activities. The remaining 20 points may be accumulated from
person-to-person OR participation in online facilitated CPD.
CATEGORY B
A maximum allowance of 10 points per year via:
 Participation in facilitated learning groups.
 Imparting knowledge relating to counselling and psychotherapy through formal presentations,
teaching, research and publications.
 Supervision participation above the annual renewal requirement
CATEGORY C
A maximum allowance of 5 points per year via:
 Contributing to the counselling and psychotherapy profession through involvement in the PACFA
Board and committees or PACFA MA committees that supports the development of the professional
identity of counselling and psychotherapy in the wider community.
 Self directed learning, logged in a reflective journal, including:
- Reading and taking notes of psychotherapy and counselling journals and books;
- Participation in online non-facilitated courses
- Participation in peer learning groups
Please attach a copy of verifying documentation relating to each PD course undertaken.
Date
CPD Activity
Provider
Category
Total Hours/Points
Updated 30/6/2016
Hours
Points
PART 6: Applicant declaration
I,
(print name) confirm that:

I have professional indemnity insurance cover in place and agree to maintain continuous
cover for the duration of my registration.

I am a current member of my member association(s).

I agree to be bound by the Code of Ethics and to comply with the procedures specified
therein.

I have never been de-registered or removed from a professional register for ethical
reasons.

I have not had any proven complaints of professional misconduct, nor performance or
disciplinary actions issued against me or my practice in the last 12 months.

If you have had any proven complaints or performance/disciplinary action issued against
you in the last 12 months, please attach documentation outlining the nature and outcome
of the complaint.

The information I have provided on this form is true and correct.
Applicant’s signature:
Date:
Please tick:
/
/
PART 7: Checklist
I have provided PACFA with the following documentation:
Please tick:

My completed log of training or professional development together with evidence for
each supervision training course or professional development activity undertaken

A copy of my current Member Association membership certificate or a copy of my
current renewal receipt

My completed Supervision documentation verified by my supervisor(s)

My application fee
Please send your application form and relevant documents to:
Nilu de Alwis
Professional Practice Administrator
290 Park Street,
North Fitzroy VIC 3068
OR via email:
[email protected]
Please include the non-refundable application fee of $80 (including GST) payable by:
Cheque made out to PACFA:
Updated 30/6/2016
Yes
Direct deposit to PACFA’s account:
ANZ Carlton
PACFA
BSB: 013-259
A/C: 4919-78993
Reference: Surname First Name
Yes
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