New Registrant Application Form

Name*

First

Last
Middle Name(s)
Previous Name (Maiden, Birth Surname)
Home Address*

Street Address

City

State / Province / Region

ZIP / Postal Code

Country
Home Phone*
Cell Phone
Personal Email*
Date of Birth*

MM

DD

YYYY
Sex*
- Female
- Male
Registration Category Applying for – Choose one classification*
- Practicing
- Provisional
Citizenship
Are you a Canadian Citizen?*
- Yes
- No
If you are not a Canadian Citizen, please answer the nest question.
If you are not a Canadian citizen, you must hold the appropriate authorization under the Immigration Act (Canada) to permit you to engage in employment in Canada. Please check the appropriate category below and submit proof of Canadian Landed Imigrant status or a valid work visa.
- Landed Immigrant
- Valid Work Visa
I am able to communicate in English or French with reasonable fluency.
- Yes
- No
When accepted to sit the certification online examination, will you require any accommodation(s)?
- Yes
- No
If you answered yes to accommodation requirements, please explain clearly below:
Current Rehabilitation Certification/Designation/Exam
Have you held the CVRP certification in the past?
- Yes
- No
If yes, please provide Certification Class and Registration Number:
Do you currently hold the CCRC, CRC or CVE or ABVE designation?
- Yes
- No
Certification and ID #:
Do you currently hold the RRP, RVP or RCSS designation?
- Yes
- No
Designation and ID #:
Do you currently hold the CDMP or CRTWC designation?
- Yes
- No
Certification and ID #:
Do you currently hold the CCLCP or CLCP certification?
- Yes
- No
Certification and ID #:
Do you currently hold any other counselling, career development, return to work or job development designations?
- Yes
- No
Designation and ID #:
Professional Liability Insurance
Documentation verifying proof of Errors and Omissions Insurance (stating name, policy number and expiry date) is not required for acceptance to write the exam but MUST be submitted to complete Registration to the College.
- Proof of E&O Insurance uploaded below
- Proof of E&O Insurance to be Forwarded
Do you have valid professional liability insurance to at least a limit of TWO MILLION ($2,000,000) per claim?
- Yes
- No
Plan held through
- VRA Canada
- Employer
Certificate Number
Expiry Date

MM

DD

YYYY
Education

Please forward original sealed transcripts directly from Educational Institution. Due to COVID 19 CVRP is accepting soft copies of transcripts.
Degree/Diploma
Name of Institution, Province/State, Country
Date of completion or convocation

MM

DD

YYYY
Major Area of Concentration
Did you complete a supervised practicum or field placement as part of this degree program? If yes, state the total hours completed and upload proof in the document uploads section.
2nd Degree/Diploma
Name of Institution, Province/State, Country
Date

MM

DD

YYYY
Major Area of Concentration
Did you complete a supervised practicum or field placement as part of this degree program? If yes, state the total hours completed and upload proof in the document uploads section.
3rd Degree / Diploma
Name of Institution, Province/State, Country
Date

MM

DD

YYYY
Major Area of Concentration
Did you complete a supervised practicum or field placement as part of this degree program? If yes, state the total hours completed and upload proof in the document uploads section.
Provisional Employment Status
Do you currently have an offer of employment to practice vocational or career consultation, rehabilitation counselling/case management or Disability Management in Canada?
- Yes
- No
Click here if this is an ongoing employment
- Ongoing
Proposed Start Date

MM

DD

YYYY
Employer #1
Name
Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Phone
Fax
Work Email*
Self Employed
- Yes
- No
Job Title
Hours Per Week
Supervisor Name/Title
Start Date

MM

DD

YYYY
End Date

MM

DD

YYYY
Click here if this is an ongoing employment
- Ongoing
Total # of Months
Has any of this employment been part of a placement or practicum associated with post-secondary education?
- Yes
- No
- NA
If yes, Name of University/College and title of Degree/Diploma
Has any of this employment experience been under the supervision of a CVRP or a CCVE?
- Yes
- No
- NA
If yes, total number of months
Role: Please check the one category that best represents the MAIN components of your work
- Rehabilitation Counselling
- Vocational Counselling
- Administration/Management
- Case Management/Disability Management
- Client Assessment
- Promotion/Planning/Consultation
- Service Planning for Individuals with disabilities
- Advocacy
- Job Analysis/Job Development/Placement Education/Research
- Return to work Co-ordination
- Rehabilitation Service Coordination
Employer #2
Name
Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Phone
Work Email
Self Employed
- Yes
- No
Job Title
Hours Per Week
Supervisor Name/Title
Start Date

MM

DD

YYYY
End Date

MM

DD

YYYY
Click here if this is an ongoing employment
- Ongoing
Total # of Months
Has any of this employment been part of a placement or practicum associated with post-secondary education?
- Yes
- No
- NA
If yes, Name of University/College and title of Degree/Diploma
Has any of this employment experience been under the supervision of a CVRP or a CCVE?
- Yes
- No
If yes, total number of months
Role: Please check the one category that best represents the MAIN components of your work
- Rehabilitation Counselling
- Vocational Counselling
- Administration/Management
- Case Management/Disability Management
- Client Assessment
- Promotion/Planning/Consultation
- Service Planning for Individuals with disabilities
- Advocacy
- Job Analysis/Job Development/Placement Education/Research
- Return to work Co-ordination
- Rehabilitation Service Coordination
Employer #3
Name
Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Phone
Work Email
Self Employed
- Yes
- No
Job Title
Hours Per Week
Supervisor Name / Title
Start Date

MM

DD

YYYY
End Date

MM

DD

YYYY
Click here if this is an ongoing employment
- Ongoing
Total # of Months
Has any of this employment been part of a placement or practicum associated with post-secondary education?
- Yes
- No
- NA
If yes, Name of University/College and title of Degree/Diploma
Has any of this employment experience been under the supervision of a CVRP or a CCVE?
- Yes
- No
If yes, total number of months
Role: Please check the one category that best represents the MAIN components of your work
- Rehabilitation Counselling
- Vocational Counselling
- Administration/Management
- Case Management/Disability Management
- Client Assessment
- Promotion/Planning/Consultation
- Service Planning for Individuals with disabilities
- Advocacy
- Job Analysis/Job Development/Placement Education/Research
- Return to work Co-ordination
- Rehabilitation Service Coordination
Employer #4
Name
Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Phone
Work Email
Self Employed
- Yes
- No
Job Title
Hours Per Week
Supervisor Name / Title
Start Date

MM

DD

YYYY
End Date

MM

DD

YYYY
Click here if this is an ongoing employment
- Ongoing
Total # of Months
Has any of this employment been part of a placement or practicum associated with post-secondary education?
- Yes
- No
- NA
If yes, Name of University/College and title of Degree/Diploma
Has any of this employment experience been under the supervision of a CVRP or a CCVE?
- Yes
- No
If yes, total number of months
Role: Please check the one category that best represents the MAIN components of your work
- Rehabilitation Counselling
- Vocational Counselling
- Administration/Management
- Case Management/Disability Management
- Client Assessment
- Promotion/Planning/Consultation
- Service Planning for Individuals with disabilities
- Advocacy
- Job Analysis/Job Development/Placement Education/Research
- Return to work Co-ordination
- Rehabilitation Service Coordination
Registration In Other Professions
Are you or have you ever been registered/licensed to practice in another regulated profession in Canada or elsewhere?
- Yes
- No
If so, provide the information requested below for EACH registration or license.
Regulatory Body 1
Prov/State
Country
License/Registration No.
Expiry Date

MM

DD

YYYY
Regulatory Body 2
Prov/State
Country
Expiry Date

MM

DD

YYYY
License/Registration No.
Conduct
I understand that the information provided on this application will be used for purposes of admission, registration, research and development, and other purposes consistent with the mandate of the College of Vocational Rehabilitation Professionals (the College). I hereby verify that the information submitted for this application is accurate. I understand that providing false or incomplete information could result in action being taken by the College, including immediate suspension of my certification of registration. I confirm that it is my obligation to notify the College within 30 days in the event that any of my information changes. I understand that submission of this application in no way guarantees my membership in the College, and that misrepresentation of this information in any way may result in cancellation of my admission or registration status. I confirm that I have never been convicted of a criminal offence, for which I have not received a pardon that is relevant to my work as a Vocational Rehabilitation Professional.
- By checking the box, I confirm that I have read, understand and agree with the above statement
Regardless of outcome, have you ever been the subject or recipient of a complaint of professional negligence through membership in a professional association or registration in a related field?*
- Yes
- No
If yes please explain*
Are you now the subject of any type of investigation, inquiry or proceeding by a professional licensing body or professional association relating to your professional conduct, competence, capacity or any other aspect of your professional practice?*
- Yes
- No
If yes please explain*
Are you aware of any facts, circumstances or situations which may reasonably give rise to a complaint other than noted above?*
- Yes
- No
If yes please explain*
I confirm that I have not been dismissed from employment, or refused membership in a professional associaiton or registration in a related field, on the grounds of professional misconduct in Canada or elsewhere.
- By checking the box, I confirm that I have read, understand and agree with the above statment.
I agree to annually review the College Standards of Practice and By-Laws. I undertake to abide by all of the rules, regulations, standards and policies of the College (the Governing Rules and Regulations”). I understand that my registration in the College is voluntary and that by becoming a registrant, I consent to the College acting as my professional self-regulating body. I acknowledge that my registered status with the College is based on the College's Governing Rules and Regulations. I agree to abide by the provisions of the Governing Rules and Regulations and I recognize that the College has the right to limit or terminate my registered status under the College’s Bylaws, Policies or Code of Professional Conduct. As a voluntary registrant, I hereby release the College of Vocational Rehabilitation Professionals from all liability for any act of negligence or want of ordinary care on the part of the College and or any of its agents. In consideration of my registration in the College, I waive, release, and discharge the College of Vocational Rehabilitation Professionals and their directors, officers, agents and members, their representatives, heirs, executors and assigns from any and all claims of liability. This agreement is binding upon my executors, heirs, and assigns. I hereby discharge and release from any liability, the College of Vocational Rehabilitation Professionals and its authorized representatives, for any acts, communications, or decisions regarding the processing, consideration, and maintenance of my registration application and file. I hereby declare that I have current E&O insurance coverage for practicing as a Vocational Rehabilitation Professional. I understand that I must submit proof of approved Continuing Education Units (CEU’s)every 2 years and must accumulate the total number of CEU’s required to maintain my level of certification, as per the College`s current Certification Maintenance Policy. The maintenance level for CEU’s is currently set at 40 (34 credits from Core Domain Learning and 6 Ethics credits) in a 2 year period. I hereby declare that the information given in this application and any attached/forwarded document(s) is, to the best of my knowledge, true, correct, and complete in every respect and that I am the College Registrant applying for renewal.
- By checking the box, I confirm that I have read, understand and agree with the above statement
Payment Options
Fees
Application and Examination Fee of $425.00 CAD + HST or GST, according to Province of Residence, is due on Submission. PayPal automatically applies appropriate taxes.*
- PayPal
There is a $15.00 administration fee plus tax(s) for cheque, bank draft or money order. Please note if submitting payment by mail, we must receive your cheque, money order or bank draft within 10 business days or your application will be voided. This application fee in NOT REFUNDABLE.
Total Payment
$ 0.00 CAD
Before Completing Your Application

CVRP applicants must complete the CVRP on-line Jurisprudence Education Module. Please submit the completed Jurisprudence certificate to info@cvrp.ca.
Please review the list below to ensure all required documents are submitted for this application. Acceptable electronic documents can be uploaded with this application (preferred – see below) or emailed to info@cvrp.ca.
Education transcripts must be sealed and sent from the education institution. Due to COVID 19 CVRP is accepting soft copies of transcripts. The Vulnerable Sector Police Checks will be required upon successful completion of examination. The original must be mailed to the College, copies will NOT be accepted. Due to COVID 19 CVRP is accepting soft copies of VSPCs.
Applicants must include the following:
- Complete the Mandatory on-line Jurisprudence Education Module
- A completed online, electronically signed, electronically dated application form;
- A mandatory application fee and examination sitting fee.
- Documentation to verify Canadian Citizenship, or authorization under the Immigration Act (Canada) to permit you to engage in employment in Canada (Upload electronic copy below)
- Documentation or written statement verifying that your official transcript(s) is being forwarded by the educational institution and all Credential(s) Verification are provided (Official Transcripts must be forwarded from Education Institution in a sealed envelope)
- Documentation or written statement of professional liability insurance coverage. If you have current insurance, if not due upon successful completion of examination.
Upload: (Copy) Vulnerable Sector Police Check – Original to be Forwarded.

Due to COVID 19 CVRP is accepting soft copies of VSPCs.
Upload: Documentation to verify Canadian Citizenship or authorization under the Immigration Act (Canada) to permit employment in Canada.
Upload: Current Cirriculum Vitae
Upload: Errors & Omissions Insurance Certificate
Upload: Copy(s) of other VR Credentials
Upload: Copy(s) of other VR Credentials
Upload: Other Documentation if required

Citizenship

Current Rehabilitation Certification/Designation/Exam

Professional Liability Insurance

Education

Provisional Employment Status

Employer #1

Employer #2

Employer #3

Employer #4

Registration In Other Professions

Conduct

Payment Options

Fees

Before Completing Your Application