2023-2024 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, 2023 to June 30, 2024. This application gathers your information for the membership roster. Please note, your membership is not active until payment is received.

We can take payment via check, Paypal, or Venmo:

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

PayPal:
https://www.paypal.com/paypalme/CASPexebd
Search for Cleveland Association of School Psychologists or CASPexebd

Venmo:
Search for CLE Association Sch Psyc or @CASPexecbd.

Email *

First Name *

Last Name *

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

Where are you employed? (For all students, please indicate your university. Interns may also include their internship placement)

Birthday Month

Street Address *

City *

Zip Code *

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

Second Year (Practicum) Student

Intern

Retired

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)

I am interested in joining the Board - please reach out to fill me in on opportunities!

Yes

Maybe

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Would you like to donate the the Valorie Wolcott Mendelson OSPA Scholarship? If yes, 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. If you do not wish to donate at this time, leave this area blank.

Send me a copy of my responses.

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