Renew Status of Endorsed Associate

renew status

Step 1 - complete online form

You will need: 

  • documentation of any Disclosure information that falls outside of the Clean Slate Legislation Act 2004 (uploadable)

Step 2 - supporting documents

You will need to:

Step 3 - return supporting documentation to dapaanz

You will need to:

  • send us the two completed forms (above) via either,
  1. email: registrar@dapaanz.org.nz
  2. post: dapaanz, PO Box 25 283, Featherston Street, Wellington 6146

Step 4 - organise payment of fee

You will need to:

  • select your payment method ( in the Payment Details section of this form so we can email invoices etc.)
  • make/arrange payment of the fee for $300.00 (incl GST)

 payment details

  • we prefer you pay by direct credit (ANZ Account: 06-0201-0631490-00). Please ensure you put your membership number and name in the reference box. If the fee is being paid by your Employer, please specify
  • if you need to pay by Cheque, please make payable to dapaanz and send to dapaanz via post/courier (as above).

*Failure to return supporting documentation will lead to delays in processing your renew status

Renew Status of Endorsed Associate

Are you a machine? If not please enter nothing in here:

You have the right to ask for a copy of any personal information we hold about you, and to ask for it to be corrected if you think it is wrong. If you’d like a copy of your information, or want to have it corrected, please contact us at registrar@dapaanz.org.nz

Please select*
First Name(s)*
Surname*
Membership Number:
Date of Birth (we collect this for reporting member statistics only)*
Ethnic Identity (we collect this for reporting member statistics only)*
Ethnic Identity (we collect this for reporting member statistics only)*
Gender (we collect this for reporting member statistics only)*
Preferred mailing address:*
Preferred mailing address (for certificates):*
Mobile e.g (64) (025) (555 5555)
Telephone (work) e.g.(64) (04) (499 3083):

Due to work emails being blocked by some servers, we request that you supply us with a personal email address, so we can keep you up to date with any news and information

Private Email:*
Organisation name and town/city:*
Your Job Description:*
Name of your Line Manager:*
Line Manager email address:*

Criminal Conviction, Complaints and Disciplinary Disclosure

To reduce risk for clients, applicants are required to disclose any prior, current or pending complaints about professional practice and disciplinary actions, and convictions that fall outside of the Clean Slate Legislation (see below).

Please answer the following questions:

Have you been convicted of a criminal offence since your last application/renewal?*
Have there been any complaints about your professional practice upheld since your last application/renewal?*
Have you been subject to disciplinary action from your employer since your last application/renewal?*
If you have answered yes to any of the questions, provide details below
Upload Disclosure Document
Additional Disclosure Document
Additional Disclosure Document
  Checking this box confirms that you have disclosed and attached all required information*

Note:   Under the Clean Slate Act 2004 you don’t need to disclose your convictions if you meet all of the following conditions:

  • No convictions within the last seven years
  • Never been sentenced to a custodial sentence e.g. imprisonment, Corrective Training, or borstal
  • Never been ordered by a Court following a criminal case to be detained in a hospital due to your mental condition, instead of being sentenced
  • Not been convicted of a “specified offence” (e.g. sexual offending, offending against children, young people or the mentally impaired)
  • Paid in full any fine, reparation, or costs ordered by the Court in a criminal case
  • Never been indefinitely disqualified from driving

Continuing Professional Development (CPD) points earned in the last year

Seventy-five points are required to renew Endorsement of Associate Practitioner status.  Practitioners are required to undertake activities from more than one category every year, except when they are undertaking formal tertiary study to the value of 100 points.

For more information on CPD points, click here

Activity Category - Formal study
List details of activities
Points earned
Activity Category - Self-directed learning
List details of activities
Points earned
Activity Category - Self-directed learning
List details of activities
Points earned
Activity Category - Self-directed learning
List details of activities
Points earned
Activity Category - Learning based on work activity
List details of activities
Points earned
Activity Category - Learning based on work activity
List details of activities
Points earned
Activity Category - Learning based on work activity
List details of activities
Points earned
TOTAL POINTS EARNED*

Upload option for CPD documents

Upload Document
Upload Document
Upload Document
Upload Document
  I verify I have undertaken the above activities over the last 12 months*

Supporting Documents

Please note: If you do not have your supporting documents  you must email them to, registrar@dapaanz.org.nz within two weeks of submitting this application

Assessment Report from dapaanz Accredited Clinical Supervisor
Support of Application from Line Manager
I will email the Line Manager and Supervisor forms seperately*

Payment Details

Please select your method of payment*

Notes

Please use the box below to note important details regarding your renewal application, e.g. you plan to email copies of CPD certificates to us at a later date etc.

Notes:
  I hereby verify that all information on this form is true and correct to the best of my knowledge and agree to abide by the Code of Ethics*

Please be aware: Due to our internal processes we may take up to one month to process your application. You should expect to receive your certificate within this timeframe.