Student Membership Renewal Form "*" indicates required fields LinkedInThis field is for validation purposes and should be left unchanged.BCACC Student Membership RenewalChecklist: What you'll need: A completed renewal form (complete online) A current proof of enrollment letter from the institution BCACC’s Processing Time and NotificationsPlease allow 2-4 weeks of processing time for the renewal process. Please note that a BCACC staff member may contact you if additional information is required. Please note that your renewal will only be processed when all necessary documents are provided. BCACC will notify you via email when: Your renewal form is submitted Your renewal membership fee is due Your renewal process is completed Step 1: Student Member InformationStudent Member Name:* First Last Student Member Number: S00*Home Address*To ensure that BCACC has your most current contact information and to comply with the BC Societies Act, please provide your current information: Street Address City Province Postal Code Mailing Address Check if same as home address Please provide your mailing address Street Address City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Phone NumbersPhone number:*Phone Ext:Mobile:*Email*In accordance with BCACC bylaws, BCACC primarily uses email to issue official association notifications. From time to time, we contact members with the release of new standards of practice/guidelines and important member surveys. To ensure that you receive the communications, please provide your primary email address below if you would like to update your email address. PRIMARY EMAIL ADDRESS Expected Graduation DateIf your expected graduation date has changed from the date you provided on the student membership application form, please provide the updated expected graduation date (MM/YY): To complete the renewal of the student membership, you must submit the proof of enrollment letter from your institution.Are you able to submit a current proof of enrollment letter?* Yes No File*Preferably a PDF, or JPG/PNG. Please note: you will not see the file being uploaded, but when you click “upload” and go to the next page, your document will be saved.Max. file size: 512 MB. Are you ready to graduate from the program soon or have you graduated recently?* Yes No If you answered no to this question and are not able to provide a current proof of enrollment letter to complete your renewal form, this renewal request cannot be completed at this time. If you have any questions, please contact [email protected] Have you started the application process for the Registered Clinical Counsellor (RCC) Designation at BCACC?* Yes No If you answered no to this question and are not able to provide a current proof of enrollment letter to complete your renewal form, this renewal request cannot be completed at this time. If you have any questions, please contact [email protected] Details3. What is the application number of the RCC application?*4. Do you currently have professional liability insurance through Mitchell and Abbott (BCACC’s partner) And/or do you plan to purchase professional liability insurance through Mitchell and Abbott?* Yes No 5. If yes, do you certify that you understand that you must be under clinical supervision by a clinical supervisor approved by the University or BCACC in order to carry professional liability insurance through Mitchell and Abbott?*YES, I certify. INITIAL HERE Step 2: Understanding BCACC’s Code of Ethical Conduct and Membership StatusAs a student member, we expect you to understand and to follow the Code of Ethical Conduct when and where applicable. Student members of BCACC agree to: Read and understand BCACC’s Code of Ethical Conduct. Assess the ethical aspects of their practices on an on-going basis with Clinical Supervisors and colleagues. Accept and consider feedback with respect to their own actions and perceived unethical behaviour and take positive steps to resolve the situation. Uphold the dignity and reputation of counselling therapy and do nothing that a reasonable and informed person would understand as bringing the practice and profession of counselling therapy into disrepute. Accurately represent themselves as individual non-voting members of BCACC. Not use the RCC designation in any way. Understand that they will not automatically achieve the RCC designation after graduation but will need to apply for this designation through regular channels. I understand BCACC’s Code of Ethical Conduct and Membership Status* Step 3: Certification and DisclosurePlease answer the following questions. Each question must be answered in order for the application to be considered.Are you the subject of investigation by any regulatory authority in any jurisdiction?* Yes No Have you been suspended, required to withdraw, expelled, or penalized by a post-secondary institution for any type of misconduct?* Yes No Have you been the subject of an ethical investigation that resulted in disciplinary sanctions or a consent agreement?* Yes No Have you been denied membership or had your registration terminated any professional body?* Yes No If you have answered YES to any of the above questions, please provide the details of why in a letter of explanation and send it by email to [email protected] before submitting the renewal form. The outcome of the letter of explanation will determine whether you should proceed with the renewal of the membership at this time.CertificationI CERTIFY that the statements made by me in this form are complete to the best of my knowledge and belief.*Your Initials:I CERTIFY that I have read, understand, and acknowledge the following:* BCACC’s Code of Ethical Conduct That I am an individual, non-voting member of BCACC and I will not represent myself as a Registered Clinical Counsellor That after I graduate from my program, I will need to apply for membership with BCACC through regular channels Your Initials:I CERTIFY that I will notify BCACC immediately in writing if circumstances change that result in the need for me to change the above disclosures.*I understand that the above-mentioned documents may change from time to time and that the onus is on me, as a professional, to be aware of these changes. Current versions of these documents can be found on the BCACC website: https://bcacc.ca/code-of-ethical-conduct-and-standards-of-clinical-practice/ Your Initials:Name of Applicant:*Signature:*Date* MM slash DD slash YYYY CAPTCHA