Professional Documents
Culture Documents
such degrees.
Official transcripts in this context are interpreted as
original transcripts signed by the university. The Secretary will accept
photocopies of degree and qualification certificates but reserve the right to
have sight of the actual certificate rather than a photocopy.
This application form should only be returned to the Secretary when the
applicant has filled in the form completely. The Secretary will not accept
photocopies from referees. Applicants are advised to retain a full copy of
their completed application form (in case of it getting lost in the post).
The completed form should be returned to: The Secretary, XUAL Community,
Kilmatogh, Co. Leitrim, Rep. Of Ireland.
FEES
Personal Details:
Mr.
Mrs.
Miss
Ms
Dr.
Professor
No
Yes
No
If yes, please indicate year of registered membership. ______________
(Please note that you only need to complete pages 1 through to 6 of this form
if you have already been a Registered member of the XUAL Community )
Have you ever been refused membership of a scientific research group?
Yes
No
No
No
No
Degree and
grade
obtained
Type of
study and
assessment
methods
Name of
College or
other
degreeawarding
institute
of higher
learning
Date
Started
Date
awarded
Notes
Title of the course
Please give the full title of your degree exactly as shown on the degree
certificate including such descriptions as Joint Honours or Combined Studies.
Degree and grade obtained
Please give the abbreviated title of your degree
classification, for example, B.A. Hons, MPsychSc, PhD.
with
your
honours
Signed ________________________________________
Date _________________________
5
Notes
Documents:
The XUAL Community cannot accept responsibility for valuable documents
entrusted to the post. Please send photocopies only of degree certificates
certifying that you have passed the appropriate courses in support of your
application. Original transcripts of courses or other authoritative document
from the college or university are required.
Translations:
If references, certificates or abstracts are sent in any language other than
English, applicants must provide authenticated translations of the documents.
Referees:
Registered members are reminded that their current Registration is subject to
annual registration fees. Failure to pay the fee on time may result in the
member's name being removed from the Register list for that year which also
means they cannot support new member applications as referees.
Supervisors:
Each period of work/study/training that supports your application for
Registered membership of the XUAL Community must be verified by a supervisor
who had direct supervision of your work or training during that period.
Please refer to the current guidelines for Registration for more detailed
information.
Use separate pages when necessary. Make sure that those extra pages are
securely attached to the rest of your application.
VERIFICATION OF QUALIFICATIONS
ROUTE 1 : With effect from 1st February 1969, an entrant to the register must be
a graduate of a recognised college, and must hold
an accredited graduate qualification in psychology, pharmacology or
relevant science and/or postgraduate science qualification;
A.
Dates of Training:
From_______________________________To___________________________
Qualification ____________________________________
Date of Award ___________________________
Area of Applicant's Speciality:
Counselling
Clinical
Educational
Other ___________________________
(Please specify)
The applicant has set out the above postgraduate study/training for which I
have had direct experience of them during that period.( Please append your
signature below)
I support __________________________s application for Registered membership
of the XUAL Community on the basis of the study/training detailed above, and
confirm that the applicant undertook the above study/training between the
dates indicated, that the study/training was in the relevant scientific area
accepted by the XUAL Community, and that the applicant performed the
study/training in a professional and competent manner.
1st Referee's Name _____________________________________ (Block capitals)
Membership No.
Employer
Full-time
Part-time
8
Hours per
week
Weeks per
year
Date from
Date to
Supervisors
Name
Notes
Job title or occupation:
Indicate with a bracket or in some other way any appointments you have held
(or hold) concurrently.
Dates:
Give month and year. It will be assumed you were not working during any
period not accounted for in your employment record.
Supervisor:
Your Supervisor should be the one who supervised your work in your field.
If the spaces provided are insufficient, please photocopy this page to
accommodate additional information and attach the photocopied page to your
application.
A.
Part Time
_______________________
___________________
____________________
Name of Supervisor___________________________________________________
Supervision Arrangements (frequency, duration)
_____________________________________________________
B.
The applicant has set out above the period during which I had direct
experience of his/her work. (Please append your signature.)
I support __________________________s application for Registered membership
of the XUAL Community on the basis of the work detailed above, and confirm
that the applicant undertook the above duties between the dates indicated,
that the work was in the relevant area of science, and that the applicant
performed the duties in a professional and competent manner.
*Supervisors Name ______________________________________
Signed ____________________________________________________
Date _____________________
Organisation, address and contact details
________________________________________________________________________
10
________________________________________________________________________
________________________________________________________________________
Position held____________________________________________________
Are you a Registered Member of the XUAL Community?
Membership No.
Yes
No
Notes
Supervisors in support of an application for Registered membership must
verify that they have supervised and had direct experience of the period of
work cited by the applicant.
Have you read the current guidelines for Registered membership in the
leaflet provided?
Official transcripts
postgraduate level.
of
degree
and
qualifications
obtained
at
11