Application form - NIP English

We are very pleased that you are interested in becoming a member of the Dutch Association of Psychologists (Nederlands Instituut van Psychologen, NIP). Becoming a NIP-member gives you numerous benefits.

a. Personal information

Gender

Initials*

First name*

Prefix

Surname*

Maiden name

Honourific (prefixing titles)

Honourific (post-nominal titles)

Date of birth*

b. Contact details

Street*

House number*

House number suffix

Zipcode*

City*

Country of residence*

Mobile phone number*

Phone number (other)

E-mail address*

E-mail address (validation)*

c. Membership information

Membership type*

Membership starting date*

International Bank Account Number (IBAN)*

Bank Identifier Code (BIC)*

Payment by direct debit*

Direct debit installment

Have you been a member of NIP before (including student membership)?

If so, what was your membership number?

d. Education

Please review the membership requirements regarding previous education on our website. In case your diploma was obtained abroad, make sure to attach your official master’s degree diploma as well as an international credential evaluation of your diploma.

University

Name of master's degree / study programme

Graduated area of specialisation

Date of graduation (master's degree/postgraduate)

Proof of graduation*

Upload a second file*

Declaration head educator of your department – only applicable if you wish to apply for the membership type of 'In postgraduate education', with a reduced contribution fee. Prerequisites for this membership type apply .

e. Choice of division

The NIP is administered by professional psychologists from a wide range of areas and specialisations, all of whom are actively involved in the NIP and its policy development. There are 18 divisions representing different fields of activity and each division has its own executive committee. As a member of the NIP, you are obliged to choose one division of preference.

First choice*

Second choice

f. Employment

Position

Company Name

Address (street + house number)

Zipcode

City

Country

Phone number

Email address

Website

Collective Labour Agreement (Dutch: CAO)

g. Statement of agreement (Choose YES to agree)

I declare that I will endorse and act upon the Code of Ethics for psychologists of the NIP. Furthermore, I will allow to be given feedback based upon these grounds by colleagues and will cooperate in the handling of any potential filed complaints concerning me.

I agree with the Statutes and Domestic Regulations of the NIP*

I agree with the association’s register being publicly available. That is: my name, NIP membership number, and any potential registrations on my name will be visible in the online ‘Find a psychologist’ (Vind een Psycholoog) register.*

I hereby declare that I have not previously been a member of the NIP, whereby I was expelled or whereby my membership was terminated by the association.*

I hereby declare that my name is not on the list of healthcare professionals that have been imposed a disciplinary measure, that is provided by the BIG-register (excluding reprimands).*

I hereby declare that I have not been imposed an order imposing limitation by the Inspection of Health and Youth Care Inspectorate or by any other government-appointed supervisor.*

I hereby declare that my name has not been removed from the youth quality register 'Kwaliteitsregister Jeugd' (SKJ).*

I hereby declare to have taken notice of the fact that the NIP membership runs and is paid per calendar year and that cancellation of the membership must be done in writing before the 15th of December of the calendar year previous to termination.*

I hereby declare to have completed this form truthfully. All information that I have provided in this form is true, complete and accurate.*

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Becoming a Member