Membership  

New members are eligible to participate in all members-only activities.

NAME: Last, First, Middle: _______________________________________________

E-MAIL ADDRESS: _______________________________________________

ADDRESS: No. & Street/City/State/Zip Code:

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WORK PHONE NUMBER:_______________________

HOME PHONE NUMBER:_______________________

OTHER PHONE NUMBER (specify):______________

DEGREE:                                             _______

YEARS OF EXPERIENCE:                _______

CURRENT POSITION: Job Title & Level_____________________

DEPARTMENT___________________________________________

DISTRICT SECTION, SCHOOL or AGENCY (SPEC. SVC., SPED, PRIVATE, OTHER:

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WORK ADDRESS: No. & Street/City/State/Zip Code:

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ISLAND:_______________________________

Are you NCSP Certified?            Yes / No

Are you a member of NASP?     Yes / No

Do you wish to join the HASP Listserve Discussion group?   Yes / No

IF YES, Indicate e-mail Address for use:

_____________________________________

SPECIALTY AREAS:_________________________________

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PLEASE CHECK THE TYPE OF MEMBERSHIP FOR WHICH YOU ARE APPLYING:

[  ] REGULAR: $20 Minimum of M.A. in School Psychology, Psychology or related field, or regular employment as a School Psychologist, Psychological Examiner III or IV, clinical or other licensed psychologist serving the needs of children in schools.

[  ] ASSOCIATE: $10 Minimum of B.A. in Psychology or related field and regular employment by Hawai's DOE as a Psychological Examiner I or II, or anyone who ascribes to the goals and objectives of the association.

[  ] STUDENT: $10 Must be enrolled in a graduate psychology program with a minimum of 6 hours per semester.

[  ] RETIRED: $10 Any former member who has retired from full-time employment but wishes to maintain HASP ties.

[  ] PATRON: $50 Organizations, offices, and agencies involved in the delivery of psychological services or materials.

MAKE CHECKS PAYABLE TO:

Hawai'i Association of School Psychologists

MAIL APPLICATION AND FEE TO: