Application Form – PSHK || Psychotherapy Society of Hong Kong

First Name(required)

Surname(required)

Email(required)

Phone(required)

Student Memberships

Student memberships are open to any person who is currently studying psychotherapy, counselling, or another mental health related subject (e.g., psychiatry, psychiatric nursing, social work, SEN education) full time at a post-secondary institution.

Please provide a copy of your student identification card.

Name of University/College

Department/Area of Study

Affiliate Memberships

Affiliate memberships are for individuals who are not qualified and/or working in the mental health field but have an interest in the goals of the PSHK.

Please tell us a little about yourself.

Current Postition/Title:

Why are you interested in joining the PSHK?:

Associate and Full Memberships

Professional Qualifications

Please list all relevant qualifications in order beginning with the highest qualification received. These should include degrees, diplomas, certifications, licenses and registrations.

(Please fill it out as per the following format. For example: BA / School at Place / 2005 / PSBody. You can enter multiple lines)

Qualifications / Name and Location of Institution / Year Obtained / Accrediting Body:

In achieving the above qualifications, what supervised clinical training did you receive? Please specify the number of hours as applicable.

Supervised Clinical Training in Psychotherapy/Counselling:

Please list any relevant/related professional memberships:

Post-training Experience in Psychotherapy/Counselling

Current Workplace and Areas of Practice/Specialties/Interests

Documentation for Full Membership

Please note, you must submit copies of relevant educational certificates and documentation (e.g., letters from supervisors, transcripts from educational institutions) confirming at least 250 hours of direct supervised clinical practise. These are the hours of therapy/counselling provided while being supervised. These hours can be in-person, online or with a co-therapist. The modality is not important (e.g., individual, group, couples, parent counselling are all acceptable). Also,100 hours of direct clinical supervision in psychotherapy/counselling are required. This is supervision you have received during which you have talked about clients you have treated.

Listing as a Member on the PSHK Website

You may voluntarily choose to be listed on the PSHK website if your membership application is approved. Please complete the following section if you would like to be listed. By completing this section, you agree to have the information you provide included on the PSHK website and that the information you provide is accurate. You also agree to update the information as necessary.

Name (as it should appear on the website):

Qualifications (e.g., M.A., Counselling):

Position(s) and Workplace(s):

Please read before submitting

Please make the first years’ dues payment with this application to
Psychotherapy Society of Hong KongP.O. Box 12097, General Post Office, Hong Kong
Cheques should be made payable to the “Psychotherapy Society of Hong Kong”
Bank transfers may be made to
Bank: HSBC Hong Kong
Account Name: Psychotherapy Society of Hong Kong
Account Number: 046 174751001
For bank transfers, please email a copy of the transfer advice to

psychotherapysociety.hk@gmail.com

I confirm that the above information is true to the best of my knowledge. I hereby apply formembership in the Psychotherapy Society of Hong Kong.

Inclusion on this list is voluntary and does not represent an endorsement by the PSHK.