NOMINATION FORM FOR FELLOWSHIP OF THE BABCP

APPLICATION FORM FOR FELLOWSHIP OF BABCP

Thank you for your application for Fellowship of BABCP.

The Fee payable on application is £150.00 by cheque. Please make cheques payable to “BABCP”. If your application is unsuccessful then you will be refunded your fee less £50.00 administration costs.

Your application will be critically reviewed and rated by the Fellowship Committee, a sub-group of the BABCP Board. It’s considered recommendation and the Board of Trustees’ decision is final. There is no appeals process.

The award of “Fellow of the BABCP” is reserved for those who have demonstrated sustained commitment to the values and objectives of the BABCP. It entitles you to use the title “Fellow of the BABCP”.

The primary aim of the Fellowship is to recognize those members who have made a significant contribution to the development of CBT and BABCP. We do not expect more than 5% of our members to fulfil the required criteria. A substantial contribution to CBT may be in areas of: (a) clinical service; and/or (b) research; and/or (c) teaching/training; and/or (d) service development; and/or (e) services to BABCP.

No documentation will be considered other than the application form and the citation of the Proposer and Seconder unless otherwise requested by the Fellowship Committee.

Applicants will be current subscribing members of the BABCP and will have held that membership for a minimum period of 5 years.

Applicants will have been engaged in the CBT field in the United Kingdom for a minimum of 10 years.

Applicants will be proposed and seconded by current subscribing members of BABCP. The Proposer and Seconder will provide a joint citation of not more than 300 words in support of the nomination.

The Proposer and Seconder should not be members of the Fellowship Committee or have any potential conflicts of interest. If a member of the Fellowship Committee is nominated for Fellowship then the member will not be involved in the evaluation of his or her nomination.

Successful applicants will be notified by post and announced in CBT Today and on the BABCP website. They will be entitled to call themselves a Fellow once their status has been confirmed.

Unsuccessful applicants will be notified by post.

Notes for completion of this form:

To enter information please set your cursor in the boxes. Moving through fields should be done with the tab key; using the return key will expand the current field.

APPLICANT’S DETAILS

We nominate for election to the Fellowship of the BABCP:

Name:

Give below a summary assessment of his/her professional career and reasons for recommendation (in no more than 300 words) (Free text)

DECLARATION

I confirm that I have read this application and to the best of my knowledge and belief the information the applicant has given is correct. I am prepared to support the case made by the candidate for election to Fellowship as recorded above in the citation that I have prepared.

PROPOSER

Full Name
BABCP membership number
Signed
Date

SECONDER

Full Name
BABCP membership number
Signed
Date


APPLICANT’S DETAILS

Full Name
BABCP membership number
Title / Mr Mrs Ms Miss Dr Prof Other (state)
Address
Post Code
Email
Tel Home / Mobile
Profession
Date of Birth
Undergraduate Education
Dates / Institution & Qualification / Job Title
Postgraduate Education / Qualifications
Dates / Institution & Qualification / Job Title
Principal Appointments since core professional training (inc. Honorary Appointments)
Dates / Employed by (or Private Practice) / Job Title
Current Appointment(s) or Position(s)
Dates / Employed by (or Private Practice) / Job Title

Your nomination will go to the Fellowship Committee, a sub-committee of the Board. Your peers will make a judgment based on quality and quantity, and due consideration will be given to all areas. The listing given below is alphabetical and does not suggest a hierarchy for rating purposes. It may feel unnatural, but you should declare what you have achieved. E.g. it is important to say you were a Course Director of your local teaching course in CBT, but what did you do that was over and above what was expected in your role? The committee recognize that some contributions are easier to describe in terms of concrete and specific achievements

Clinical Service to Clients

(Maximum 400 words) (Free text)

What have you done over and above what may be expected for clients to improve your quality of care? Have you developed specific expertise? Have you provided an exceptional service in the absence of support? Please highlight your top two achievements, including year, in this section.

Research

(Maximum 400 words excluding references) (Free text)

How have you made a significant contribution to the knowledge base through research? Provide a description of your research in the development or practice of CBT. Provide a maximum of 15 references of your papers with the highest impact. List any major grants or awards. Please highlight your top two achievements, including year, in this section.

Examples: “I developed a model for peer supervision over a webcam and compared it to using the ether by randomisation to 4 different centres. We were able to demonstrate that webcam is an effective method of supervision.”

Research References

Please use the space given below to give details of your top ten references (or copy and paste in priority order from your C.V.).

Teaching/Training

(Maximum 400 words excluding references) (Free text)

Provide a description of your significant contribution to teaching, which may include introducing innovative ideas. Applicants should describe the significance/impact of the training. Provide a maximum of 15 references of teaching articles, books you have written or courses and workshops you have provided. List any awards or honours achieved.

Examples:

“I developed an innovative teaching workshop for BABCP conferences for applying statistics for single case experimental designs. At the end of the workshop, students are able to use a randomization test for multiple baseline designs. It has been rated as highly satisfactory”

Teaching/Training References

Please use the space given below to give details of your references (or copy and paste in priority order from your C.V.)

Service Development, Administration or Management

(Maximum 400 words) (Free text)

Give details of any ways that you have developed a service for clients; provided leadership or a management role in your organisation or contributed to policy making. List any awards or honours achieved. Please highlight your top two achievements, including year, in this section.

Examples:

“I developed a specialist service for trapped finger pain. At our last audit, our clients rated our service as very satisfactory.”

“I have managed our local CBT department for the past 3 years. During this time I managed to persuade my line manager to increase our budget for an extra 2 therapists. Throughout this period I was able to pay for 80% of my staff to attend the BABCP conference.”

“I was on the NICE committee that developed guidelines for bloated head syndrome. Without my contribution, it is unlikely to have developed the guidelines for this syndrome.”

Services to the BABCP

(Maximum 400 words) (Free text)

Give details of any voluntary role that you have done for the charity and what you achieved during that time. Please highlight your top two achievements, including year, in this section. List any awards or honours.

Example: “I was the Chair of the Outer Hebrides Branch of the BABCP from 2001-2003 and during that time, I led a team that increased the number of workshops from 1 to 3 per year, and increased the average attendance from 10 to 50.“ “I was Editor of the BABCP Journal from 2001-2007 and during that time, our impact factor rose from 1 to 2.”

Please provide any other information relevant to your professional career for nomination.

(Maximum 400 words) (Free text)

Criminal, Civil, Investigatory & Disciplinary Declarations
All applicants must answer each of the six questions below
If you answer YES to any question, please declare details on an attached statement
Question / Declaration / Additional Statement Enclosed / Labelled as
1.  Have you ever been convicted of any criminal offence in any court in the UK or elsewhere which might prejudice the public’s trust in you, your profession, or the BABCP, if accurately informed about all the circumstances of the case? / YES
NO
2.  Have you ever been found guilty of a civil offence? / YES
NO
3.  Have you ever been refused / expelled from membership of any other professional body / register on the grounds of professional misconduct or other professionally related offence? / YES
NO
4.  Have you ever been the subject of any professionally related disciplinary action (which may or may not have ended in dismissal)? / YES
NO
5.  Are you currently / likely to be the subject of any criminal, civil, investigatory or disciplinary proceedings or enquiries? / YES
NO
6.  To your knowledge, have you ever been, or are you likely to be involved in a situation or incident likely to result in disciplinary action against you as a member of the BABCP? / YES
NO

DELIBERATELY FALSE STATEMENTS WILL RESULT IN YOUR REMOVAL FROM THE LIST OF MEMBERS

DECLARATION

I agree to be nominated as a Fellow of the BABCP, will abide by the rules of the nomination process, and understand that the decision of the Fellowship Committee and Board is final.
Signature / Date

Completed forms should be sent with your remittance of £150.00 to

Freepost RSHG-HYHY-LSHJ

BABCP

Imperial House

Hornby Street

BURY

BL9 5BN

V1-0510 2