ASTO Associate Application Form
Applications must be complete before they are reviewed
Please read instructions carefully, and include all required documentation. Your application will automatically save. Changes can be made up until the application is submitted. 

**The application form for Healthcare Affiliates is below this one**

1. Complete all pages of the application form in English.
2. Applicants must ensure submission of recommendation letters, transcripts and other relevant materials accompany this application to
3. The non-refundable application fee of $50 is required before the review process begins. Once your
application has been submitted with all required documents, instructions for payment will be emailed to you by the registrar.
4. You will receive a confirmation email from the Registrar within 5 days of receiving ALL of your application documents.
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Email *
Name: *
Preferred Pronouns *
Workplace Address: *
Telephone: *
Current Employer: *
Primary Designation *
Regulating College and Registration Number: *
Malpractice insurance carrier AND policy number AND  date of renewal *
CAMFT Fellow? *
Academic Experience
Highest Academic Degree Achieved.   *
Department / Field *
Name of Accredited Institution *
Year Awarded *
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