2020-2021 CASP Membership Application

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Thank you for joining the Cleveland Association of School Psychologists!

Below is the application for membership in CASP from July 1, 2020 to June 30, 2021. This application gathers your information for the membership roster. Please note, your membership is not active until payment is received.

Checks/POs can be mailed to:
Melissa Bestgen, Membership Chair
755 Robin Dr.
Eastlake, OH 44095

You can now pay electronically!

With Venmo:
Send your payment via Venmo to first name CASP, last name Execboard.

With PayPal:
Find us by searching for Cleveland Association of School Psychologists or CASPexebd on the PayPal site, or typing paypal.me/CASPexebd into your browser

Email *

First Name *

Last Name *

Title (Psy.S, ED.S, Ph.D, etc)

Where are you employed? (District, agency, organization, etc)

Birthday Month

Street Address *

City *

Zip Code *

Email Address *

Phone Number

I am a member of the following additional organizations: *

OSPA

NASP

ISPA

OPA

APA

CPA

Other:

Required

The following apply to my licensure/practice: *

Ohio Department of Education Certified/Licensed School Psychologist

Ohio Board of Psychology Licensed School Psychologist

Nationally Certified School Psychologist (NCSP)

Other Licensed Psychologist

University Trainer

Private Practice

First Year Student

Practicum Student

Intern

Other:

Required

The above information may be shared with fellow CASP members......

Upon request (do not need to contact me)

With permission (contact me)

Not at all

Other:

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Membership Type *

Member ($25.00)

Intern ($10.00)

Student ($5.00)

Retired ($5.00)

Lifetime Member Honoree (no fee)

Would you like to donate the the Valorie Wolcott Mendelson OSPA Scholarship? Please indicate your donation amount below.

The Valorie Wolcott Mendelson OSPA Scholarship has been established to award two scholarships each year to a deserving Ohio student pursuing a career in school psychology. If you would like to contribute to the scholarship, please send your donation with your membership dues. CASP will forward the donations to the scholarship fund. One check can be submitted to cover both your dues and donation amount.

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