AACP Application for Liaison Membership

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AACP is a national network of community psychiatrists and allied mental health professionals and peers committed to promoting health, recovery and resilience in people, families and communities.

Please complete the following form to apply for liaison membership to the AACP

Name *

Email Address *

What is your profession? *

Psychiatric Nurse Practicioner

Psychologist

Social Worker

Counseling professional

Other:

Required

In what setting do you currently work/practice? *

Administration/Management

Assertive Community Treatment Team

Community mental health center

Federally qualified health center or other setting integrated with primary care

Inpatient hospital unit

Jail/Prison

Outpatient clinic

Private Practice

Short term residential crisis center

Residential treatment

Homeless shelter or homeless outreach

Other:

Required

Mailing Address *

What kinds of resources, skills and/or supports are you interested in receiving through the AACP?

For renewing members, What have you found most useful/valuable about being a member of AACP?

Are you a new or returning member to the AACP? *

New Member

Returning Member

Required

Phone *

What is the number of years you have been out of training?

Please complete your application by submitting payment of $100.00

Pay $100 here via PayPal or Credit Card:
https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=QB97C4ZTXMBH4

(Note: PayPal account not required to pay via credit card- simply check out as guest)

or use Venmo name @community-group

Submit

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