Allegheny County School Counselors Association Membership Registration 2019-20
Thank you for your interest in joining this professional community of school counselors and related professionals from Allegheny County. Please complete the form below. **PAYMENT CAN BE MADE VIA PAYPAL OR CHECK. Check back on ACSCA website!
Last Name *
Your answer
First Name *
Your answer
Your PPID Number (if you do not provide this, you will not be able to earn credit for ACT 48 hours for professional development- if you do not have one please write "none") *
Your answer
Title
Example: School counselor, director of counseling, OVR coordinator, social worker, dean, etc...
Your answer
School District or Organization *
Your answer
Building Name *
Your answer
Mailing Address Line 1 *
Your answer
Mailing Address Line 2
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Preferred Email Address for ACSCA Communications *
Your answer
Preferred Contact Telephone Number *
Your answer
1st Time Members: Did a current ACSCA member tell you about ACSCA? If so, list who below..
Your answer
At what type of institution are you employed? *
Please note that our organization encourages membership from a wide variety of stakeholders. However in order to be a Professional, and therefore voting member, you must be employed as a school counselor in Allegheny County. Non-Allegheny counselors are welcome to join as Associate members.
Membership Level at which you will be joining the organization? *
Level (Check all that apply) *
Please indicate which level(s) of students you work with.
Required
Should you agree by providing the information below, our organization would like to contact your supervisor to alert them of your membership in this organization. For school counselors, this is an important part of meeting the Danielson model for school counselor evaluation. Please provide your supervisors FULL NAME, including Dr/Mrs/Mr/etc.
Your answer
Supervisor's Email
Your answer
Any specific professional development topic you hope to see covered this year:
Your answer
Are you interested in possibly joining the ACSCA leadership team in any way? (committee chairperson, executive board, etc.)
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