Application for Fellow Status in IPA
IPA is interested in honoring all deserving full members eligible for Fellow status.  

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Have you been a member of IPA for at least five (5) years?
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Do you have five (5) years of progressively responsible professional post-doctoral experience?
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Please describe the above post-doc experience below:
Has any disciplinary action been taken against you by the Idaho Board of Psychologist Examiners in the last five (5) years?
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Do you have at least four (4) years of professionally-related volunteer service with a minimum of two (2) of the four (4) years for IPA?                                            [The remaining may be sole or combined in the following: IPA or another State, Territorial, Provincial Psychological Association (SPTA); APA or another national or regional psychological association; the Idaho Board of Psychologist Examiners or another official board of psychologist examiners; or professionally-related service to the community.]
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Briefly describe volunteer service below:
AFFIDAVIT:  I hereby certify, under penalty of perjury, that my responses to each of the above questions are current, true and correct and are furnished in good faith.                                                                                                             Please type your name below in agreement to the above.
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