Psychological Practitioners Registration Regulations 2003
PSYCHOLOGICAL PRACTITIONERS REGISTRATION
REGULATIONS 2003
1
BR 11/2003
PSYCHOLOGICAL PRACTITIONERS ACT 1998
1998 : 26
THE PSYCHOLOGICAL PRACTITIONERS REGISTRATION
REGULATIONS 2003
In exercise of the powers conferred on him the by section 22 of
the Psychological Practitioners Act 1998 the Minister of Health and
Family Services makes the following regulations:
Citation and commencement
1 These Regulations may be cited as the Psychological
Practitioners Registration Regulations 2003 and shall come into force on
10 March 2003.
Application for registration
2 An application for registration under section 8 of the
Psychological Practitioners Act 1998 shall be made to the Registrar-
General in Form 1 of the Schedule and shall be accompanied by—
(a) copies of any professional qualifications mentioned in
the application;
(b) copies of any other documents relating to professional
qualifications, experience and character which are to be
relied on for the purposes of the application.
Application for renewal of certificate
3 An application for renewal of a certificate under section 11 of the
Psychological Practitioners Act 1998 shall be made to the Registrar-
General in Form 2 of the Schedule.
Notices
4 Where any provision of the Psychological Practitioners Act 1998
requires notice in writing of any matter to be given to a person, the notice
shall be hand delivered to that person and a signed and dated receipt
shall be provided by him or on his behalf.
PSYCHOLOGICAL PRACTITIONERS REGISTRATION
REGULATIONS 2003
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SCHEDULE
FORM 1 (Reg 2)
APPLICATION FOR REGISTRATION AS A PSYCHOLOGIST
All applicants must complete PART A. Applicants who are not registered
or licensed outside Bermuda must also complete PART B.
To: The Registrar-General
I hereby apply for the entry of any name in the Register of
Psychologists maintained by the Registrar-General under section 8 of the
Psychological Practitioners Act 1998.
I declare that to the best of my knowledge and belief the
information given in this form is true.
Signature of applicant.............................................................
Date.......................................................................................
PERSONAL PARTICULARS
Surname: ...............................................................................
Full given names: ...................................................................
Date of Birth: .........................................................................
Address: .................................................................................
Nationality: ...........................................................................
Bermudian Status YES/NO
Ordinarily Resident in Bermuda YES/NO
PART A - APPLICANTS REGISTERED OR LICENSED OUTSIDE
BERMUDA
1. Details of any previous certification and licensure including
accrediting body, certificate number, date awarded and most
recent renewal:
....................................................................................................
................................................................................................
2. Details of formal education beyond secondary school including
degrees, certificates and other academic qualifications including
the date of award:
PSYCHOLOGICAL PRACTITIONERS REGISTRATION
REGULATIONS 2003
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....................................................................................................
................................................................................................
3. Details of training beyond formal education including continuing
education credits and recent experience:
....................................................................................................
................................................................................................
4. List the names and addresses of two persons who may be
contacted with respect to your good character and experience:
Name:..........................................................................................
Address: ......................................................................................
Name:..........................................................................................
Address: ......................................................................................
5. Other information you consider relevant to the determination of
your application:
....................................................................................................
................................................................................................
6. Have you been convicted of an offence and sentenced to
imprisonment. If so provide details:
....................................................................................................
................................................................................................
PART B - APPLICANTS NOT REGISTERED OR LICENSED OUTSIDE
BERMUDA
7. Details of academic work at the graduate or postgraduate level:
....................................................................................................
................................................................................................
8. Postgraduate training including placement, nature of training,
number of hours and identity of supervisors:
....................................................................................................
................................................................................................
PSYCHOLOGICAL PRACTITIONERS REGISTRATION
REGULATIONS 2003
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FORM 2 (Reg 3)
RENEWAL OF REGISTRATION
To: The Registrar-General
I hereby apply for the renewal of my registration as a
psychologist under section 11 of the Psychological Practitioners Act
1998.
I declare that to the best of my knowledge and belief the
information given in this form is true.
Signature of applicant............................................................
Date.......................................................................................
Surname: .............................................................................
Full given names: ..................................................................
Date of Birth: .......................................................................
Residential Address:
....................................................................................................
................................................................................................
Address of place of employment:
....................................................................................................
................................................................................................
Date of initial registration: .......................................................
Expiration Date: ......................................................................
Certificate Number: ..................................................................
DETAILS OF ACTIVITIES IN THE LAST THREE YEARS
1. Psychological services, including hours and nature of service
provided:
....................................................................................................
................................................................................................
2. Continuing professional development, including credits therefor:
....................................................................................................
PSYCHOLOGICAL PRACTITIONERS REGISTRATION
REGULATIONS 2003
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................................................................................................
3. Educational or other requirements imposed by the Psychologists
Registration Council:
....................................................................................................
................................................................................................
4. Conviction of an offence and sentenced to imprisonment:
....................................................................................................
................................................................................................
Made this day of March, 2003
Minister of Health and Family Services
