This application form is applicable for individuals who are fully qualified or practicing independently as an MFT or Systemic Family Therapist or related mental health profession. Proof of qualification must be submitted along with completed application.

1. Member Information:

Prefix:

Name:

Gender:
—Please choose an option—MaleFemale

Date of Birth:

National ID/Passport/Alien ID/ Maisha Card number:

Primary Work Setting (e.g. hospital, school, private practice etc.):

Country of Practice:

Address:

Organization:

Street Address:

Postal Address:

Phone:

Email:

2. Member Credentials

Please indicate the degree which you would like to have listed in your SFTAK membership record. This should be the degree that qualifies you to practice independently as an MFT. The degree you choose will appear in all correspondences and in SFTAK’s online Membership Directory.

Degree:

University from which your degree was obtained:

3. Would you like to be listed in our online Membership Directory?

—Please choose an option—YESNO

4. Statement of Professional Ethics and Conduct:

(if your answer is ‘yes’ to this question, please send us an email on info@sftak.org with detailed information)

Have you ever been convicted of a felony or of any misdemeanor which might relate to your qualifications or functions as a therapist or other professional; or have you ever had your registration, certification or license to practice in the healthcare industry suspended, revoked, restricted or denied; or has any other disciplinary action been taken against you by any federal, state, or provincial regulatory body or foreign jurisdiction; or are you presently under investigation by any regulatory body to the best of your knowledge?

—Please choose an option—YESNO

5. Membership Fees

Professional Membership Registration Fee: KES 5,100. Renewal of Membership KES 2,550 annually.

Membership fee is payable to;

MPESA
SFTAK Paybill Number: 4130353, Account number: your name

Bank: Stanbic Bank Kenya
Account Name: Systemic Family Therapy Association of Kenya

Account number;
Kes: 0100012774146
Usd: 0100012774178

Swift Code: SBICKENX
Bank Code: 31000
Branch Code: 1019
Branch: Buruburu

6. Special Interest Groups

Select one or more of the SFTAK Special Interest Groups:

Community Mental HealthRelational Health and TraumaSpiritualityGrief

7. Upload Documents

University Degree (PDF, DOC, DOCX)

National Identity (PDF)

8. Mpesa/Bank Proof of Payment

Please enter proof of payment