MEMBERSHIP APPLICATION
| Name:_____________________________________________________________________________________
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| Street:_____________________________________________________________________________________
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| City, State, Zip: ____________________________________________________________________________ |
| Home phone:________________________________________________________________________________ |
| Email address:_______________________________________________________________________________ |
| School district:_______________________________________________________________________________ |
| School/School Phone:_________________________________________________________________________ |
| Languages spoken in addition to English:____________________________________________________________ |
| I am willing to be a CASP liaison for my school system:________________________________________________ |
I have read the membership categories and accurately reflected my current status.
Categories of Membership
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£
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Professional: Those
certified by the Connecticut state Department of Education as school
psychologists, or by other states with comparable standards. Those trained as
school psychologists, but currently functioning as a consultant or supervisor of
school psychological services, or engaged in the training of school
psychologists at a college or university. (Fee:
$75.00) A copy of your certification must be enclosed if you are changing from Student or Associate to Professional member. |
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£ |
Student:
Those enrolled in a school psychology program, approved by the
Connecticut state Department of Education, who do not qualify as a Professional
member. Those who have completed an approved program in school psychology and/or
who are certified and are completing an internship in school psychology. (Fee:
$25.00) Name of institution: _________________________________________________________________________________ Signature of a faculty sponsor required yearly. |
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£ |
Associate: Members of
other professions or the community who wish to join CASP to support the works of
the organization, and to receive the general mailings of the organization;
Certified or trained school psychologists who are no longer employed, who are in
some other related position, and who maintain an active interest in the
profession of school psychology. (Fee:
$45.00) |
|
£ |
Retired: Members age 55 or over who have held professional membership for at least five consecutive years and who are retiring from remunerative professional activity. Those members having reached the age of seventy or having been retired members of CASP for at least 10 years may accept or decline free lifetime membership. (Fee: $30.00 / $ 0.00 If retired 10 years or age 70+) |
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Please make checks payable to CASP and send to: |
CASP |
| 15 Hilltop Drive | |
| Simsbury, CT 06070 |