Applicant Reference Number :
UK Registration of Overseas
Genetic Counsellors
Application Form 2012
IMPORTANT NOTICE
CURRENTLY UNDER REVIEW
Applicants must review the GCRB Report on UK
Registration for Overseas Genetic Counsellors
(GCRB website) to determine if they are eligible to
submit this reduced version of the portfolio. They
must also delete sections of this proforma that do not
apply to them (e.g. those trained and certified in the
USA and Australia may have different UK registration
requirements).
Applicants must also read the general Applicant
Guidelines in full for instructions on how to submit the
portfolio and what happens in the assessment
process.
Overseas Applicant Portfolio Version 1 Date: May 2011
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Applicant Reference Number :
REGISTRATION PORTFOLIO FORM:
Part A
PERSONAL DETAILS AND SIGNATURE OF AUTHENTICITY
Surname of applicant
First name(s)
Title
DOB
Please give the work address for all your current, relevant posts
Work address
Work telephone number
Email address
Names, job titles, and
professional relationship of
2 referees (one of these
will be the Sign-Off Mentor)
1.
2.
Declaration by applicant
I declare that I have provided the material and information in this portfolio
sections A,B and C honestly and it is the result of my own work.
eSignature
Date
Applicant:
Signoff Mentor
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Applicant Reference Number :
RECORD OF CONTINUING PROFESSIONAL DEVELOPMENT
If certification was granted more than 5 years ago, you must provide evidence of ‘Continuing Professional Development’ for the past 5 years (i.e. a
minimum of 30 hours per year of learning activity relevant to area of practice, at least 50% of which must be external to the applicant’s department. This
includes relevant courses, conferences, journal clubs, seminars, lectures or publications)
READ CPD GUIDELINES BEFORE COMPLETNG
SUMMARY OF HOURS COMPLETED
Year
From
To
1
1/4/20_ _
31/03/20_ _
2
1/4/20_ _
31/03/20_ _
3
1/4/20_ _
31/03/20_ _
4
1/4/20_ _
31/03/20_ _
5
1/4/20_ _
31/03/20_ _
Internal hours
External hours
Total
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Total hours
Applicant Reference Number :
CPD REFLECTIVE RECORD
Date of
CPD
Activity
(D/M/Y)
Number of hours
Internal
External
Type and title of CPD activity
(including title of the
conference/activity/presentation;
name of the speaker; the location of
the conference or presentation)
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Reflection and implications for practice
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Applicant Reference Number :
Please also list any publications/presentations over the past 3 years
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Applicant Reference Number :
REFLECTIVE RECORD OF TWO COUNSELLING SESSIONS
Case 1
Code
eSignature of
counselling
supervisor:
Name of counselling supervisor (please also
provide counselling qualifications and
details of supervision training):
Brief description of case
Comments by genetic counsellor on session
Comments by supervisor on session
Describe what was learnt from the session and feedback
Case 2
Code
eSignature of
counselling
supervisor:
Name of counselling supervisor (please also
provide counselling qualifications and
details of supervision training):
Brief description of case
Comments by genetic counsellor on session
Comments by supervisor on session
Describe what was learnt from the session and feedback
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Applicant Reference Number :
CASE LOG BOOK
Please provide the following details for the five cases observed by your Sign-Off Mentor in clinic.
Number
1
2
3
4
5
Registration family code
Diagnosis at referral
Final diagnosis
Draw pedigree
Take medical history
Take psychosocial history
Discussion of family’s needs
Documentation of diagnosis
Provide information on condition
Assess risk
Explain inheritance pattern
Discuss tests
Discuss reproductive options
Arrange screening program
Provide additional psychological
support
Refer to other agency
Discuss case at clinical meeting
Present option for client to be involved
in research
Document case appropriately
Initialled eSignature of
mentor
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Applicant Reference Number :
Overseas Registration Portfolio Part C
CASE STUDY
The case study should demonstrate the applicant’s knowledge and understanding of
counselling theory and its application to practice. The rationale for the application of a
particular counselling approach should be justified.
Please note there is a limit of 2000 words (not including references). There is 10%
flexibility on this word limit, i.e. the absolute maximum that will be accepted is 2200 words,
with a lower limit of 1800 words.
The referral letter, pedigree, case note summary and any letters should be available if
requested for viewing by the Sign-Off Mentor.
ESSAY
Please submit a 5000 word essay/reflective piece, which reflects on the different health
systems and related agencies between the country of training and the UK. An awareness
of UK genetic counselling practice should be demonstrated, to include a documentation of
how the individual handles a clinical case, discussing cultural awareness, ordering of
genetic tests and the process of referral. A Master’s level of academic writing must be
demonstrated throughout. There is 10% flexibility on this word limit, i.e. the absolute
maximum that will be accepted is 5500 words, with a lower limit of 4500 words.
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Applicant Reference Number :
OVERSEAS REGISTRATION PORTFOLIO: PART D
STRICTLY CONFIDENTIAL
SIGN-OFF MENTOR'S REFERENCE
Name of Applicant:
Name of Sign off Mentor:
Job Title:
GCBR Registration Number (if
applicable):
Contact number:
Work address:
Professional relationship to
applicant:
Length of time applicant
known:
Please tick the box below:
I support the submission
I have reservations about the submission
From the evidence seen in the portfolio, please comment on:

Adequacy and currency of the applicant’s genetic knowledge base and expertise
overall

Applicant’s self-awareness, recognition of boundaries and ability to liaise
appropriately with colleagues
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Applicant Reference Number :

Applicant’s professional/academic activities

Applicant’s use of counselling supervision (as defined by the AGNC Supervision
Working Group Report on Supervision, 2006) and practice within the AGNC Code
of Ethics (http://www.agnc.org.uk/About%20us/codeofethics.htm) and the GCRB
Code of Conduct (http://www.gcrb.org.uk/Files/Code%20of%20Conduct.pdf)

Assessment of five observed consultations with case log numbers
I confirm that I have discussed the case study and essay with the applicant and
that it is the work of that individual.
eSignature of
Sign-Off Mentor
Date
Case Study title:
Essay title:
Please verify the portfolio content as being undertaken by the applicant.
eSignature
Date
Sign Off Mentor:
Please submit reference by email to the GCRB Administrator (enquiries@gcrb.org.uk)
(preferably in PDF format) by 1st May.
GCRB Administrator
Overseas Applicant Portfolio Version 1 Date: May 2011
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Applicant Reference Number :
OVERSEAS REGISTRATION PORTFOLIO: PART E
STRICTLY CONFIDENTIAL
MANAGER’S REFERENCE
Name of Applicant:
Name of Manager:
Job Title:
GCBR Registration Number (if
applicable):
Contact number:
Work address:
Professional relationship to
applicant:
Length of time applicant
known:
The Manager or Senior Colleague must be able to include comments on:

Efficiency of caseload management

Adequacy of record keeping, both within local policies and standards of record
keeping (http://www.nmc-uk.org/Documents/Guidance/nmcGuidanceRecordKeepingGuidancefor
NursesandMidwives.pdf) (http://old.rcplondon.ac.uk/clinical-standards/hiu/Documents/GenericRecord-Keeping-Standards.pdf)

Effectiveness of team participation including contribution to service planning and
audit.

The applicant's practice within the AGNC Code of Ethics and the GCRB Code of
Conduct (available on the GCRB website)

The applicant's continuing professional development.
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Applicant Reference Number :
eSignature
Date
Manager’s:
Please submit reference by email to the GCRB Administrator (enquiries@gcrb.org.uk)
(preferably in PDF format) by 1st May.
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Applicant Reference Number :
OVERSEAS REGISTRATION PORTFOLIO: PART E
STRICTLY CONFIDENTIAL
Reference from previous line manager from Country where
Certification/Registration was granted
Name of Applicant:
Name of Manager:
Job Title:
GCBR Registration Number (if
applicable):
Contact number:
Work address:
Professional relationship to
applicant:
Length of time applicant
known:
Please comment on the following areas of practice giving examples where possible:

Confirmation of length of time working in the department

Clinical and counselling skills

Confirmation of knowledge about qualifications and genetic counselling certification
eSignature
Date
Sign Off Mentor:
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Applicant Reference Number :
Please submit reference by email to GCRB Administrator (enquiries@gcrb.org.uk)
(preferably in PDF format) by 1st May.
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