Washington State Association of School Psychologists
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WSASP Membership Form
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Applicant Name

   Last   First   MI 


Current Address

Street 

    City   State   Zip 


Telephone

Home  -  - 

 Work   -  - 


Fax

Home  -  - 

 Work   -  - 


E-mail


Employer


Job Title


Highest Degree Earned


Areas of Special Interest

How did you learn about WSASP?   

Are you interested in volunteering?        NCSP?   


Membership Categories

Membership year is October 1 - September 30.

Membership Type  

School Psychologist members must provide the following:

Certificate No.    State 

Associate members must possess a minimum of a Bachelor's degree, and cannot hold office or vote.

Student members must be carrying six (6) or more semester hours, and provide the following:

Student Trainer/Supervisor

Last   First   MI 


Payment

 .

Make checks payable to:
Washington State Association of School Psychologists
P.O. Box 525
Cheney, WA 99004

For Purchase Order payment, you must provide the following:

PO No.   District Name 


Verification

I hereby verify that the information provided is accurate and agree, in making this application, to abide by the Professional Standards and Ethical Codes of the Washington State Association of School Psychologists, and the national ethical and professional standards of my profession.


  
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