Membership Application

IMHPJ is committed to supporting the highest standards of ethical and professional practice by the international community of mental health providers here in Japan. With that in mind, all applicants must review the IMHPJ Code of Ethics before completing this application.
  • Membership Application

    IMHPJ is a voluntary association of professionals and is not a licensing body. Membership is divided into four categories: Clinical, Associate Clinical, Affiliate and Overseas Alumni. Please use the following information to determine the category for which you qualify.
  • Confidential Information

    The information you provide on this form is used only: 1) to verify your qualifications 2) to certify your membership level; and 3) to communicate among IMHPJ members regarding IMHPJ-related matters. Your information will not be used for any other purpose and will not be shared with any 3rd parties.
  • All applicants should list academic degrees with dates of completion and places of study. Please upload photocopies below. (If you are also licensed or registered in your home country, please provide license/registration numbers, photocopies and website addresses to verify their current status, etc.)
  • Drop files here or
  • If you are applying for Clinical Membership, has your training included 2500 clinical hours with at least 250 hours of direct supervision?
  • NOTE: There are several ways to assist us to verify your training experience and credentials: 1) With website info and a copy of a license or registration. 2) Or, with official document copies that show your hours of clinical work with hours of supervision. 3) Or, with a letter detailing how you meet the criteria above, with verifiable data, wherever possible.
  • If you are applying for Associate Clinical Membership, please tell us about your clinical experience and supervision, and provide evidence. Please see the NOTE above regarding verifying clinical experience for reference.
  • If so, will you give us more details with contact information?
  • If applying to become an Affiliate Member, please tell us about yourself and your interest in IMHPJ. Please attach documents, wherever possible, to verify education, any licenses, if listed.
  • NOTE: In order to be listed publicly on our website and in other directories, photocopies of all relevant academic degrees, licenses, registrations, and professional organization memberships must be included with this application, with translations if necessary.
  • Date Format: MM slash DD slash YYYY
  • Your signature here indicates that you meet the requirements for the membership category for which you’re applying.