I confirm

1. I am a current member of DeepBrainReoreinting Ltd and agree to adhere to the DBR Professional Code of Good Standing, Policies and Procedures of the organisation related to my being a member, for at least the next three years.
2. I understand that I must maintain my membership to retain my DBR Approval certificate. Where membership is forfeited or breached, my DBR Approval will be reviewed and potentially withdrawn.
3. I am currently registered with a professional body and have current practice indemnity insurance
4. I will continue to engage in ongoing consultation of my professional DBR clinical and/or consultation practice with an Approved DBR-C.
5. The Approved DBR-C providing a reference has seen evidence of a minimum of 30 CPD points from various activities for this 3 year period
6. I can and will provide all evidence outlined within this application where my application is needed for auditing purposes by the DeepBrainReoreinting Approval Panel
7. I confirm that I will inform DeepBrainReorienting Ltd of any breach of any Professional code to which I am subject to, and of any sanction, suspension, disciplinary action or investigation to which I am subject by any other regulatory or governing body throughout the period of my DBR-P or DBR-C Approval certification.

To be completed by DBR-C Re-Approval applicants only.

Please tick the activities that you have been involved in and provide detail below of at least two of these.  We would like to understand how these activities have supported your growth and development as an Approved DBR-C.

Two Approved DBR-C referees are required for both DBR-P and DBR-C Re-Approval

Where a DBR-P does not have a second DBR-C able to provide a reference, a person of good professional standing who can comment meaningfully on the work and standing of the DBR-P can be used. A DBR-C must provide 2 references from DBR Approved Consultants.

Please provide commentary about the applicant including:

• their clinical practice learning and development over the 3 years since approval
• their professional good standing
• any recommendations of areas for further development

Additionally, for DBR-Consultant Re-Approval:

• their role as a consultant offering consultation to DBR professionals
• their demonstration of consistently promoting excellence in pursuit of the science; professionalism in mentoring of DBR professionals; and integrity in the clinical practice of DBR (as the applicant has detailed in Section 4)