Student Registration

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.

1. Member Information:

Prefix:

Name:

Gender:

Date of Birth:

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

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

Country of Study:

Address:

Organization:

Street Address:

Postal Address:

Phone:

Email:

2. Current Enrollment Information

Institution name:

Program of Study:

Current year of study:

Expected Degree (e.g. MA,MSc etc):

Expected Graduation Date (Month/Year):

3. 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 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?

4. Membership Fees

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

5. Special Interest Groups

Select one or more of the SFTAK Special Interest Groups:

6. Upload Documents

Undergraduate Degree* (PDF, DOC, DOCX)

Acceptance/Enrollment Letter* (PDF, DOC, DOCX)

National Identity* (PDF)

7. Mpesa/Bank Proof of Payment

Please enter proof of payment*