Page 1 of 4 If you are an existing BASW member or have had a BASW membership within the past two months then please contact our membership team directly on 0121 622 8401, please do not complete this form.. BASW Membership is currently only available for qualified social workers, or students studying for a recognised social work qualification; the membership team will verify the qualification fields have been completed. If you are not a qualified social worker or are not studying to become a social worker, but are interested in an Associate BASW membership, please contact the membership team on 0121 622 8401. Previous BASW membership Have you previously ever held a membership with BASW? Yes No Your details Title * - Select -MsMrMrsMissMxDrProfSirRevLordLadyDameCaptainBrotherSisterDeaconProfessorRt Hon First name * Last name * Birth date * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Employment details Are you actively working (in an employed, self-employed or a voluntary capacity in which you are a social worker or using your social work skills)? * Select 'no' if you are a full-time student studying to become a social worker - Select -YesNo Academic Please tick if you are working in academia Are you working more than 25 hours per week? * - Select -YesNo Employer/ Voluntary Organisation/ Business Name (if self-employed) * Job title * Sector * - Select -Local AuthorityGovernmentPrivateVoluntary/ CharityAcademicNHSAgencySelf-EmployedOther (Please State) Sector (if other) * If you are not actively working, are you: * - Select -A StudentNot working Home contact details Phone number * Please enter mobile numbers preceded by + country code, no preceding 0 and no gaps. e.g. add 07890 123 456 as +447890123456 Phone type * - Select -LandlineMobile Email address * Please ensure you provide a personal email address in this field that is unique to you, and is not shared by anyone else including colleagues. We use this to communicate about membership matters - you can opt into promotional mailings when you join us. Postal code * Enter your postcode to find your address (leaving a 1 character space between the first and second parts of the postcode e.g. B2 5PP; E1 6DQ) Address * Address line 2 Address line 3 Town/ City * County * Country GuernseyIsle of ManJerseyUnited Kingdom Work contact details Phone number * Please enter mobile numbers preceded by + country code, no preceding 0 and no gaps. e.g. add 07890 123 456 as +447890123456 Phone type * - Select -LandlineMobile Email address * Please ensure you provide a personal email address in this field that is unique to you, and is not shared by anyone else including colleagues. We use this to communicate about membership matters - you can opt into promotional mailings when you join us. Postal code * Enter your postcode to find your address (leaving a 1 character space between the first and second parts of the postcode e.g. B2 5PP; E1 6DQ) Street address Address line 2 Address line 3 Town/ City County Country GuernseyIsle of ManJerseyUnited Kingdom Main contact details Phone number * Please enter mobile numbers preceded by + country code, no preceding 0 and no gaps. e.g. add 07890 123 456 as +447890123456 Phone type * - Select -LandlineMobile Email address * Please ensure you provide a personal email address in this field that is unique to you, and is not shared by anyone else including colleagues. We use this to communicate about membership matters - you can opt into promotional mailings when you join us. Postal code * Enter your postcode to find your address (leaving a 1 character space between the first and second parts of the postcode e.g. B2 5PP; E1 6DQ) Street address * Address line 2 Address line 3 Town/ City * County Country GuernseyIsle of ManJerseyUnited Kingdom Qualifications / Courses Did you qualify outside of the United Kingdom? * - Select -YesNo Country of qualification * - Select -United KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo, Republic of theCongo, The Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d’IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSerbia and MontenegroSeychellesSierra LeoneSingaporeSint Maarten (Dutch Part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Date of qualification * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050205120522053205420552056205720582059206020612062206320642065206620672068206920702071207220732074 Qualification * - Select -BA (Hons)BSc (Hons)BSWCQSWMNSWMAMScMSWPG DipPhDOther (Please State) Other Qualification * Course title * - Select -Adult Nursing and Social WorkApplied Social WorkChildren's Nursing and Social WorkIntegrated Practice in Learning Disabilities, Nursing and Social WorkLearning Disabilities, Nursing and Social WorkMental Health Nursing and Social WorkNursing (Learning Disability) and Professional Social Work PracticeSocial WorkSocial Work and Applied Social StudiesSocial Work (Children and Families)Social Work PracticeSocial Work (Step up to Social Work)Social Work StudiesSocial Work with Honours in Social Work, Ethics and ReligionStep up to Social WorkOther (Please State) Other course title * University or institution * - Select -Anglia Ruskin UniversityBangor UniversityBelfast Metropolitan CollegeBirmingham City UniversityBradford CollegeBridgend CollegeBrunel UniversityBuckinghamshire New UniversityCanterbury Christ Church UniversityCardiff Metropolitan UniversityCardiff UniversityCity College NorwichCoventry UniversityDe Montfort UniversityEdge Hill UniversityGlasgow Caledonian UniversityGlyndwr UniversityGoldsmiths, University of LondonHavering College of Further and Higher EducationHeart of Worcestershire CollegeKeele UniversityKingston UniversityLeeds Beckett UniversityLiverpool Hope UniversityLiverpool John Moores UniversityLondon Metropolitan UniversityLondon South Bank UniversityManchester Metropolitan UniversityMiddlesex UniversityNew College DurhamNorthumbria University at NewcastleNottingham Trent UniversityOxford Brookes UniversityQueen's University of BelfastRobert Gordon UniversityRoyal Holloway, University of LondonRuskin CollegeSheffield Hallam UniversitySouthampton Solent UniversityStaffordshire UniversitySurrey and South London Partnership with Royal HollowaySwansea UniversityTeesside UniversityThe Frontline OrganisationThe Open UniversityThe University of NorthamptonUniversity of BathUniversity of BedfordshireUniversity of BirminghamUniversity of BradfordUniversity of BrightonUniversity of BristolUniversity of Central LancashireUniversity of ChesterUniversity of ChichesterUniversity of CumbriaUniversity of DerbyUniversity of DundeeUniversity of DurhamUniversity of East AngliaUniversity of East LondonUniversity of EdinburghUniversity of EssexUniversity of GloucestershireUniversity of GreenwichUniversity of HertfordshireUniversity of HuddersfieldUniversity of HullUniversity of KentUniversity of LancasterUniversity of LeedsUniversity of LincolnUniversity of ManchesterUniversity of NottinghamUniversity of PlymouthUniversity of PortsmouthUniversity of ReadingUniversity of SalfordUniversity of SheffieldUniversity of South WalesUniversity of SouthamptonUniversity of StirlingUniversity of StrathclydeUniversity of SuffolkUniversity of SunderlandUniversity of SussexUniversity of the West of England, BristolUniversity of the West of ScotlandUniversity of UlsterUniversity of WarwickUniversity of West LondonUniversity of WinchesterUniversity of WolverhamptonUniversity of WorcesterUniversity of YorkOther (Please State) Other university or institution * Expected date of qualification * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050205120522053205420552056205720582059206020612062206320642065206620672068206920702071207220732074 Did you relocate to the UK in order to practice social work? * - Select -YesNo Social worker registration information Are you a registered social worker? * - Select -YesNo Regulatory body * - Select -NISCCSCWSSSCSWE Regulatory body no. * Check your regulator’s website if you don’t know your registration number View our Privacy Policy to find out how we collect, use and protect your data. 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