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Membership Application 2023-2024
Membership runs from September 1 to August 31
* Indicates required question
Email
*
Record my email address with my response
Full Name
*
Your answer
Address
*
Your answer
Primary Phone
*
Your answer
Secondary Phone
Your answer
Primary Email
*
Your answer
Secondary Email
Your answer
Professional Affiliation
Your answer
Certification/License Number
Your answer
Employer
*
Your answer
County
*
Your answer
Today’s Date
*
Your answer
Type of Membership
*
Initial Membership
Renewing
Type of Membership
*
***EARLY BIRD Special for those who join before October 31, 2023 will get a $5 discount of the price shown below.
Full Member ($26, Individual licensed or certified as a school psychologist, faculty position)
Retired/Emeritus Member ($26, full members who formally retired)
Student Member ($16, students interested or enrolled in a school psychology program)
Affiliate Member ($26, Individuals in a related field)
Honorary (Free, appointed and subject to approval of majority by executive board)
What type of role do you serve? (check all that apply)
*
School Psychologist
Bi-Lingual School Psychologist
Supervisor
Administrator
Trainer/Educator
Clinical Psychologist
Counselor
Consultant
Other:
Required
Employment-check all that apply
*
Public School
Private School
Residential Institution
Private Practice
Mental Health Agency
College/University
Other:
Ages Served-check all that apply
*
Preschool
Elementary School
Middle School
High School
Post-Secondary
All of the Above
Required
Are you willing to serve on a committee?
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Yes
No
Maybe-Tell me more!
Check any committees that you would be interested in helping out this year!
Community service - planning group wide community service events
Training - planning, organizing and implementing our annual training day
Elections - recruiting, organizing and implementing NEFASP voting procedures
Professional - facilitating the School Psychologist of the Year process and excellence awards
Social Committee - planning and implementing social events
Payment Amount
*
Free-Appointed/Honorary Member, Board Member
+16.00 - Student Member
+26.00-Full Member, Retired/Emeritus Member, Affiliate Member
-5.00-Early Bird Discount $21.00 (Payment before October 31, 2023)
Required
After you click the submit button, please use the PayPal link on the next page to pay for membership.
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