INTERNATIONAL SCHOOL PSYCHOLOGY ASSOCIATION
Application for (please identify category):
Affiliate Associations
Mission Partners
(Please fill out in capital letters)
Name of Association: ____________________________________________________
Country: __________________________________
State/Province: _____________________________
Name and mailing address of the Association:
________________________________________________________________________
________________________________________________________________________
Email address: _______________________________________
Website URL: _____________________________________
Name and mailing address of President or Chairperson:
________________________________________________________________________
_______________________________________________________________________
Email address: _________________________________________
Number of Members: __________
Are the members school psychologists only? _____________________________
If not, what percentage of members are school psychologists? ___________
What other professions are
represented in your association?
______________________________________________________________________
Goals of the Association as described in the Constitution and Bylaws (Please attach the constitution. If the document is not in English, please list here in English the Association goals):
Does your association publish a journal and/or a newsletter?
Title of Newsletter: _______________________________________________
Title of Journal: _________________________________________________
Name and mailing address of newsletter editor:
__________________________________________________________________
_________________________________________________________________
Email address: _________________________________
Name and mailing address of journal editor:
______________________________________________________________________
______________________________________________________________________
Email address: ________________________________
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The President/Chairperson of (name of the Association):____________________________________________________
requests status as an affiliate/mission
partner with the International School Psychology Association. The Executive
Board of
_________________________(name of the Association) appoints
Mr./Ms./Dr. ____________________ as its representative to
ISPA and as the contact person between the Association and ISPA.
Please return this application to: ispacentraloffice@ispaweb.org
If
returning via mail, send the application form to: Dr. Bob Clark, ISPA Central
Office, National-Louis
University, 122 South Michigan Avenue, Chicago,
IL 60603-6119, USA.
Tel: (1) 224-233-2596
FAX: (1) 224-233-2112
If your application is approved by the Executive Committee of ISPA, you will receive notification and you will be asked to pay the membership fee. The minimum fee for affiliation is $150. Larger contributions from national, state, or provincial associations are most welcome.