To apply for StopSO membership, please complete this form and send over all proofs, including: Insurance (min £2 Million), Qualifications, Training, Professional membership, Photo etc. You will also need to send a reference from your Supervisor and a Referee. These forms will be sent to you upon completion of the membership form. Once we have received all your documentation, applications can take up to 3 months to process, so please be patient. PLEASE READ: In order to become a member of STOPSO you are required to comply with the following criteria: Agree to abide by the Good Therapy – STOPSO Code of Ethics and Practice. Have completed a minimum of 30 hours continuous professional development (CPD) in the last year (see Practice Guidelines - Continuing Professional Development). A minimum of 8 hours CPD must be relevant to sexual offending/sexual abuse therapy. Be a practitioner working in the field of therapy with at least 100 hours of face-to-face work in the last year. While it is understood that supervision may form part of a Member’s clinical practice, it is recommended that there is a balance between supervision and clinical practice so that it does not constitute your sole mode of practice. Practitioners who have been accredited for over 5 years are exempt from this criterion as long as they are continuing to work in the field Have had no unauthorised breaks in practice of longer than twelve months. Have adequate specialist supervision (preferably with a STOPSO recognised Supervisor) for the caseload you carry, i.e. not less than one hour per month (see Practice Guidelines – Supervision and the Supervision Contract). To confirm this, your supervisor’s signature is required. Be adequately insured (£2,000,000 minimum). Sign the member declaration (page three). In completing this application form, you are agreeing to our terms and conditions. A membership fee of £50 will be payable upon receiving your first referral. Please be aware that STOP SO expects all registered therapists to work ethically within their professional membership guidelines. Any issues of concern that come to the attention of STOP SO will be dealt with expediently. STOP SO reserves the right to cancel the membership of any therapist whose conduct brings the organisation into disrepute. You agree to StopSO holding your information on a database and in computer files and to them sharing your name and contact information with clients. NOTE: STOPSO reserves the right to change any of the criteria required for membership or annual renewal of accreditation and to audit the applications by requiring documentary evidence to be produced on request. Name* First Last Email* Date of Birth* MM slash DD slash YYYY Phone - Landline Phone - Mobile Website Home Address*Work Address*Work Address Post Code* Qualifications*Please attach proofQualifications Proof #1Accepted file types: pdf, doc, docx, jpg, png, pages, Max. file size: 30 MB.Qualifications Proof #2Accepted file types: pdf, doc, docx, jpg, png, pages, Max. file size: 30 MB.Date StopSO training completedPlease attach proof MM slash DD slash YYYY Date StopSO training completed - ProofMax. file size: 30 MB.Specialist training working with sex offenders*Specialist training working with sex offenders - proofAccepted file types: pdf, doc, docx, jpg, png, pages, Max. file size: 30 MB.Specialist training working with sex offenders - proof #2Accepted file types: pdf, doc, docx, jpg, png, pages, Max. file size: 30 MB.Hourly rate* Concession rate Do you work on Zoom/Skype or similar?* Yes No Supervisor Name and contact detailsReferee Name and contact detailsAnything else we should know about you?Please advise us of your ethnicity* Annual Hours of Therapy*Can you confirm you have completed at least 100 hours of face-to-face or online therapy during the past year? If not please provide information as to why this criterion has not been met. Senior practitioners, who have been accredited for five years are exempt from the clinical practice criterion, as long as they are continuing to work in the field of sexual and relationship therapy. You must continue to meet all the other criteria to renew your accreditation. Yes No Breaks in Practice*Have you had, or do you anticipate having a break in practice of more than 12 months. Yes No Breaks in Practice - Details*Supervision*Can you confirm you have been in regular, ongoing supervision or consultation at the required levels over the past year? If No please enclose further information Yes No Supervision - Details*Continuing Professional Development*Can you confirm you have completed a minimum of 30 hours of Continuous Professional Development in the year prior to this renewal? A minimum of 8 hours must be relevant to sexual offending/sexual abuse. Yes No Client agreement*Please confirm you are using a written client agreement. Yes No Indemnity Insurance*Can you confirm you have Professional Indemnity Insurance of not less than £2 million Yes No Not Applicable NHS Employees*Can you confirm you have Clinical Negligence Scheme and Risk Pooling Scheme? Yes No Not Applicable Insured amountIf none of the above please give details below and the amount you are insured for Professional membership*Are you registered with UKCP, BACP, NCS or COSRT Yes No Professional membership - Other*If not registered with UKCP, BACP, NCS or COSRT, please give details of other membership Over the past year:A - Have there been any criminal or civil convictions or proceedings, upheld or pending, against you?*If Yes, please give details Yes No More details*B - Have there been any complaints or disciplinary proceedings, upheld or pending, brought against you?*If Yes, please give details Yes No More details*C - Have you had your membership of any professional body withdrawn?*If Yes, please give details Yes No More details*D - Do you have a current DBS check?*Please attach proof Yes No DBS Check - ProofAccepted file types: pdf, doc, docx, jpg, png, Max. file size: 30 MB.Practice detailsAreas of practice*Please confirm which of the below groups you are able to work with by ticking all the apply Under 18 Survivors Couples Offenders – contact Offenders – online only or before crossing the line Practice locationsPlease list below the postcode of any locations you have practice roomsAddressPost Code Member Declaration I confirm that I am a current member of STOPSO. I confirm my commitment to maintain ongoing supervision, personal and professional development for the duration of my membership. I confirm that all the above statements are true and that I agree to abide by the governing documents of STOPSO. STOPSO are signatories to The Second Memorandum of Understanding against Conversion Therapy. By signing the declaration you are confirming the following: I will not advocate or use conversion therapy, which assumes that any one sexual orientation or gender identity is superior to or preferable to any other. I will not seek to work in such a way as to impose or attempt to impose change in a client’s self-determination of sexual orientation or gender identity. ConfirmationBy signing this declaration you are confirming the above I confirm