APS Membership Change of Name or Title Form

APS Membership Change of Name or Title Form

You must provide us with documentation before we can change your name on our records.
Please advise the details which you wish to change:*

Your nameYour title

To change your name

To allow the APS to change your name on the APS membership database, please provide your details below.

Please attach either a high quality scanned copy or an originally certified copy of your official proof of name change document (e.g. marriage certificate, change of name certificate), and submit the form.

For information about how to have your documents certified, please see the instructions below.
APS member number*
Date of Birth*

DayMonthYear
Date
Email*
example@example.com
Previous name in full*
Enter your name as it is currently held in the APS database
New name in full*
Please include all first names and your last name
File Upload*

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To change your title

To change your title, please enter the relevant details below.
APS member number
Full name

First nameLast Name
Previous title
New title
Are you changing an academic title?

YesNo
Is the new title listed on your AHPRA record?

YesNo
You can check the AHPRA register here.
Simply enter your AHPRA registration number below and submit the form.
Registration number
Please use the file upload below to upload either a high quality scanned copy or an originally certified copy of your supporting documentation, for example, your official academic transcript showing completion of your doctoral studies.

Certified copies are photocopies of documents, where each page has been originally sighted & signed by an appropriate certifying officer such as a Member of the APS (MAPS), accountant, Justice of the Peace, pharmacist, physiotherapist, police officer or psychologist.

Each page must be marked or stamped “certified as a true copy of the original” and include a legibly printed name, signature, profession and registration number, and contact number of the certifying officer. The certifying officer must not be a spouse or family member.
File Upload

Cancelof
Should be Empty:

APS Membership Change of Name or Title Form

To change your name

To change your title