SFTAK
This application form is applicable for students who are currently enrolled in a graduate Marriage and Family Therapy Program at an accredited university. Proof of enrollment in an MFT Program must be submitted along with completed application.
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 Study:
Organization:
Street Address:
Postal Address:
Phone:
Email:
Institution name:
Program of Study:
Current year of study:
Expected Degree (e.g. MA,MSc etc):
Expected Graduation Date (Month/Year):
(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 student therapist or other professional;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
Student Membership Registration Fee: KES 3,100. Renewal of Membership KES 1,550 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
Select one or more of the SFTAK Special Interest Groups:
Community Mental HealthRelational Health and TraumaSpiritualityGrief
Undergraduate Degree* (PDF, DOC, DOCX)
Acceptance/Enrollment Letter* (PDF, DOC, DOCX)
National Identity* (PDF)
Please enter proof of payment*