SPS Membership Application Form v 30.10.2016 1

SPS Membership Application Form

Full / Overseas Full Membership Bachelor/Master* degree in psychology or equivalent, recognised by the society AND 2 years of relevant work experience.

Yes / No

Bachelor degree in psychology or equivalent, recognised by the society, together with a further qualification in psychology which may be a Masters or a Doctoral degree or equivalent.

Yes / No

Master/Doctoral/Postgraduate professional* qualification in a specialised field in psychology from a recognised academic institution, such qualification having entailed supervised practical training of not less than 400 hours in a variety of settings.

Yes / No

Licensed/Chartered/Registered* psychologist legally entitled to practice as a professional psychologist in one of the following countries or states: Australia, Canada, New Zealand, USA, UK or Great Britain and Northern Ireland, or such other countries as the Council may from time to time determine.

Yes / No

Full membership with an overseas national psychological society recognised by the society.

Yes / No

Associate / Overseas Associate Membership (Please select one) Degree with 50% of curriculum in Psychology

General degree in Psychology

Honours degree in Psychology

Master degree in Psychology

Affiliate / Overseas Affiliate Membership I have completed tertiary education. Yes / No

Tertiary Institution: _________________________________________________________________________________

Student / Overseas Student Membership

I am currently enrolled in one or more Psychology courses at a tertiary institution.

Part Time / Full Time

Tertiary Institution: __________________________________________________________________________________

SPS Membership Application Form v 30.10.2016 2

Personal Particulars (This form will require approximately 15 minutes to complete) Full Name (as in NRIC/Passport)*

Mr / Mrs / Mdm / Miss / Dr / Professor:

Name in Chinese Characters (if

applicable):

Alias / Other Name (if applicable):

NRIC No / Passport No*: Colour*: Pink

Blue

NA

Expiry Date*:

DD / MM / YYYY

Residential Address*:

Postal Code*:

Work Address:

Postal Code:

Overseas Address (if applicable):

Contact: Home* ________________________________

Handphone*____________________________

Email*_________________________________

Office_________________________________

Fax ___________________________________

Date of Birth*:

DD / MM / YYYY

Place of Birth*:

Marital Status*: Single

Married

Others: ________________________________

Sex*: Male

Female

Religion*:

SPS Membership Application Form v 30.10.2016 3

Ethnicity*:

Dialect Group*:

Nationality*:

Citizenship*:

If PR, please state PR start date:

Education Qualifications* (in chronological order) Qualification

Attained Start Date

DD/MM/YYYY Name of

Institution & Country

Date of Award / Expected

Date of Completion

Accreditation Agency Full or

Part-Time/Distance

Education

Membership in Professional Bodies Year

Accepted

Association / Society Membership Category

SPS Membership Application Form v 30.10.2016 4

Employment History Date Started

DD/MM/YYYY Date Ended

DD/MM/YYYY Job Title / Occupation Employer

Referees (Two Full Members Required)* Name Membership No. Tel No. Email

SPS Membership Application Form v 30.10.2016 5

Areas of Interest in Psychology (Maximum 250 words)

Please indicate ways in which you may like to contribute to the work of the

Singapore Psychological Society (Maximum 250 words)

Privacy of Information I consent to having the above information published in SPS Membership Directory. Yes / No

Declaration

Have you been or are you currently under investigation by any disciplinary or legal

tribunal? Yes / No

Have charges of unprofessional conduct ever been brought against you?

Yes / No

Have you been convicted in the past 10 years of an offence involving a criminal

charge or is there any charge pending? Yes / No

I hereby declare that all information/documents submitted by me in this application

is true and accurate. Yes / No

I understand that any misleading statement, or omission may be cause for rejection

of this application. Yes / No

I hereby declare that pending acceptance and if accepted, I agree to be bound by the

Constitution of the Singapore Psychological Society as amended in 2004 and the

Society Code of Ethics.

Yes / No

SPS Membership Application Form v 30.10.2016 6

Payment Information Please be reminded that payment of SPS membership and processing fees should accompany this application. Do note that payment of an incorrect amount would lead to a rejection of this application. Please choose either payment through PayPal, cheque, internet banking or GIRO as per instructions below. If cash payment is preferred, please do not submit cash by post. Contact the secretariat office (details below) to discuss suitable alternatives.

Membership Fees (accurate as of July 2015)

Membership Type* (please choose one) Amount (Note: All stated amounts are in SGD) Full Membership $75 Associate Membership $60 Affiliate Membership $45 Student Membership

$30

**Please note that there will be an administrative fee of $30 for all applicants (local/overseas). For overseas applications, an additional $30 overseas fee for processing and postage will be charged.

This is to be paid over and above the above stated membership fees.

Payment Instructions: The preferred mode of payment is through the PayPal portal, which can be found on the SPS membership application webpage: http://wp.me/P6E67E-Wb. PayPal Please set up a PayPal account (if you do not have one) through the links on the SPS membership application webpage and choose the appropriate category of membership. You may also pay through the following options: Cheque Payment Please issue a cheque made to payee: Singapore Psychological Society with respective payment amount. Please write your full name or membership number, if available at the back of the cheque for easy verification. Internet Banking Payment If Internet banking is preferred, please arrange for a bank transfer to: A/C Name: Singapore Psychological Society A/C Number: 070 002 366 0 Bank Code: 7171 Branch Code: 070 Swift Code: DBSSSGSG If paying by internet banking or PayPal, please indicate the transaction reference number and take a print screen of transfer amount made and email / attach it together with your application package. Please also include your full name or membership number in the email / attachment for easy verification.

Please send your application package and all relevant documents to the following address: Singapore Psychological Society

SPS Membership Application Form v 30.10.2016 7

Secretariat Office 8 Eu Tong Sen Street #18-81 The Central Singapore 059818

Email: secretariat@singaporepsychologicalsociety.org

Important notes:

(1) If you respond Yes to any of the above questions, please submit an explanation and/or

details of the outcome. Mark it Private and Confidential and send it to the Membership

Committee. In considering your application, the Membership Committee or Members of the

Council of SPS may request further information. A Yes answer does not automatically mean

a rejection of the application. Each application will be considered on its merits.

(2) As part of the membership application process, all applicants need to be nominated by 2

current full members of the society, who must sign and provide his/her membership

number on the nominators’ section above. Only applicants for international membership are

exempted from completing this section of the form.

(3) SPS will require transcripts to be mailed directly from the home institution. Copies of

supporting documents (Based on the information you provided for your academic

qualifications, Professional Memberships & Employment) have to be certified true copies.

Certified true copies mean photocopies stamped and signed as a true copy by the awarding

university, awarding organization, Advocate & Solicitor, a Notary Public, a Justice of Peace or

embassy ONLY.

(4) The certifying officer must not be a family member or spouse. Please submit certified true

copies of marriage/partnership certificate, deed poll etc., if your name is now different from

that on the certificates. Please note that we will not accept copies of documents certified by

staff of current/past employer(s).

(5) SPS will email you on receipt of your application. Please arrange for the payment of your

processing fee by Internet Banking or cheque made payable to ‘Singapore Psychological

Society’.

(6) You will be given your reference code to check the status of your application. Please retain

your reference code should you require our assistance.

*Compulsory fields

SPS Membership Application Form v 30.10.2016 8

Character Reference (Form 1)

The character referee should be a full member of Singapore Psychological Society who has known the applicant for a year or more.

I, (name of referee) ________________________________________, solemnly declare:

(1) I have known (name of applicant) __________________________________ in the capacity of

______________________________________ (not a family member).

(2) I have known this person for a period of ___________________ years.

(3) To the best of my knowledge this person has not engaged in any professional misconduct.

(4) This person is of good fame and character.

Designation: _________________________________________

Address:

_________________________________________ _________________________________________ _________________________________________

Tel: (W)___________________________ (H)____________________________

Email: _________________________________________

Signature: ______________________________ Date: __________________________

SPS Membership Application Form v 30.10.2016 9

Character Reference (Form 2)

The character referee should be a full member of Singapore Psychological Society who has known the applicant for a year or more.

I, (name of referee) ________________________________________, solemnly declare:

(5) I have known (name of applicant) __________________________________ in the capacity of

______________________________________ (not a family member).

(6) I have known this person for a period of ___________________ years.

(7) To the best of my knowledge this person has not engaged in any professional misconduct.

(8) This person is of good fame and character.

Designation: _________________________________________

Address:

_________________________________________ _________________________________________ _________________________________________

Tel: (W)___________________________ (H)____________________________

Email: _________________________________________

Signature: ______________________________ Date: __________________________

SPS Membership Application Form v 30.10.2016 10

Checklist for Manual Form Submission

1.

SPS Membership Application Form Yes / No

2.

Transcripts sent directly from awarding school / institution Yes / No

3.

Certificate of Membership in Professional Bodies (Certified true copies)

Yes / No

4.

Employment History (Letters of employment from organisation)

Yes / No

5.

Character Referees (Two full character references)

Yes / No

6.

Payment of Membership Fees (Attached / emailed transaction reference number and print screen where appropriate / Giro form)

Yes / No

7.

Local Admin Fee: $30 Overseas Admin Fee: $30 (processing) + $30 (overseas processing) = $60 *This is to be paid over and above respective category membership fees

Yes / No