Application to Register with the Complementary & Natural Healthcare Council (CNHC)
Name of professional association
International Cranial Association (ICRA)
ICrA Membership Number
(your name)
Email address
Date of birth
I give permission for you to check my details and then confirm my eligibility to CNHC for the purposes of
entry to the CNHC Register in the following disciplines: (please tick)
Craniosacral Therapy
Name
Signed
Date
Please return your completed form BELOW direct to ICrA which will verify your registration.
When ICrA has processed your form they will send it to CNHC for you. You will then be sent an
automatic email from the CNHC inviting you to complete your registration online.
The CNHC registration fee is £60 for your first discipline.
Each additional discipline costs £10 up to your 4th discipline, after which there is no fee for
additional disciplines.
If you do not have an email address you can apply offline. Once ICrA has verified your application CNHC
will send you postal information to complete and return to them to process. Please be advised that there
will be a £10 administration fee for those who wish to apply offline as CNHC will need to manually
process your application. Registrants will then receive a hard copy registration certificate via post.
CNHC contact : Tel: 020 3178 2199 / Email: [email protected] / Website: www.cnhc.org.uk
1
Application for Verification
NOTE: Applicants are required to have professional indemnity insurance
Practice details
PERSONAL DETAILS
Title:
Gender:
Surname:
Forename/s:
Contact Address:
(Inc postcode)
Home Telephone:
Work Telephone:
Mobile
Email address:
PRACTICE WEB
SITE ADDRESS
I confirm that I have Professional Indemnity Insurance
Company:
Policy number:
Expiry date:
THERAPIES
COVERED
LEVEL OF
COVER (£)
Your practice
Practice address
Please describe your current practice arrangements
Number of
other
practitioners
Number of
patients you see
per week
2
Hours per
week
worked
Therapies you
offer and % of
time/ numbers on
each
Qualifications
NOTE: if you qualified in craniosacral therapy after 1997 at one of the Colleges that have been
validated against the National Occupation Standards for Craniosacral therapy, your application can be
fast tracked. (see CNHC web site for details).
If you cannot be fast tracked, your application will be assessed on both training and experience
(APEL). We need to know about ALL your healthcare training, your practice history, and other registered
therapies. As a guide, the requirements are that you have been in continuous practice for at least 3 years
AND have training in anatomy and physiology AND have completed 30 days cranial therapy training. The
minimum is 10 days training plus 7 years in practice.
Three Case Studies are also required (guidance on last page) if you are NOT a Statutory Regulated
health professional such as osteopath, chiropractor, nurse or HPC-registered profession.
NOTE If your training was through shadowing and mentoring rather than formal taught
courses, please describe in full giving hours and nature of training, on extra pages
OFFICE USE
ONLY
COLLEGE
COURSE TITLE
AWARD/
DEGREE
NUMBER
OF TAUGHT
DAYS
COMPLETION
DATE
VERIFIED/
NOT VERIFIED/
NOT
APPLICABLE
PLEASE NOTE THAT WE MUST HAVE PROOF OF ALL QUALIFICATIONS HELD. PLEASE
ATTACH A COPY OF QUALIFICATION CERTIFICATE(S). (PLEASE DO NOT SEND ORIGINALS AS
THESE CANNOT BE RETURNED)
3
Continuing Professional Development
The CNHC requires at least 15 hours of CPD annually of which at least 10 hours must be specific to
cranial therapy. See the CNHC web site for activities which count towards CPD
http://www.cnhc.org.uk/index.cfm?page_id=29
DATE
Please list ALL CPD undertaken in past 5 years. Use up to 2 additional sheets
RELEVANT
COURSE TOPIC
ORGANISATION
HOURS/
DAYS OF TO
CRANIAL
CPD
THERAPY?
4
Safety and professional standing
MEMBERSHIP OF PROFESSIONAL ORGANISATIONS AND REGISTERS
ORGANISATION
MEMBERSHIP NUMBER
Specifics
Have you been in continuous practice as a cranial therapist for the
past 7 years?
If not please specify how many years
Have you ever had a complaint against you or your practice from a
member of the public?
If yes, please specify
Have you ever been convicted of any criminal or civil offence (apart
from speeding)?
If yes, give details and penalty imposed.
YES
NO
YES
NO
YES
NO
Please give date of your current CRB certificate?
If you do not have one, please state reason
YES
NO
Please give date of you current First Aid certificate?
If you do not have one, please state reason
YES
NO
Which private health insurers are you recognised by? please state
which ones
YES
NO
Do any Health practitioners refer patients to you?
If yes, give main sources
Do you refer patients to other health care practitioners for further
treatment of investigation? If so, give main routes of referral
YES
NO
YES
NO
5
Character
Reference Form
A reference as to the applicant’s character is to be provided on this form by a person of professional standing in the community, who
is not a relative and who has known the applicant for at least 3 years. The referee must know the applicant well enough to make a
judgement as to the applicant’s integrity, trustworthiness and honesty.
People of professional standing include JPs, lawyers, accountants, health care professionals, religious officials or senior figures in
business, the public sector or voluntary sector.
Name of Applicant
Address
The above person has applied to join the Register of CNHC, the voluntary regulatory body for
complementary health practitioners. In order to be eligible to be admitted to the Register, the
applicant must satisfy CNHC that he/she is of good character.
Referee’s Name
Occupation
Practice or Business
Contact Address
Telephone Number
and Email address
Please state in what capacity the applicant is known to you:
Please complete as appropriate
I am satisfied that, to the best of my knowledge, the applicant is of good character and fit for
registration (please tick)
YES
If NO above: the CNHC should be aware of the following details of the applicant’s character, which might
affect his/her suitability for registration (continue overleaf if required)
Date:
Signed:
For any queries or help completing this form, please email [email protected] or call CNHC on 02031 782199
6
NO
Three Case Studies
These are ONLY required for applications from practitioners who are NOT Statutory Regulated.
The guidance for case studies is currently based on that developed by BANT for Nutritional
Therapy, which can be accessed from these links.
http://www.bant.org.uk/bant/pdf/nonBANTCNHC/EXTERNAL_FULL_PORTFOLIO_CASE_S
TUDY_INSTRUCTIONS.pdf
http://www.bant.org.uk/bant/pdf/nonBANTCNHC/EXTERNAL_FULL_PORTFOLIO_EXAMP
LE_CASE_STUDY.pdf
Please follow the BANT guidelines as applicable to your cranial therapy practice and submit the
case studies with your application.
7
Download

Application for Verification - International Cranial Association