Counselors for Social Justice University Chapter Application
IMPORTANT: THIS FORM CANNOT BE SAVED --
WE RECOMMEND YOU REVIEW THE APPLICATION CONTENT AND MAKE SURE THAT YOU HAVE ALL INFORMATION PREPARED TO COMPLETE THE APPLICATION.

If you have any questions, the CSJ Membership Committee can be reached at: Membership.CSJ@gmail.com. Additional guidelines and examples are available on the CSJ website: https://counseling-csj.org/csj-chapters/

Chapter CSJ organization name: *
Your answer
Chapter CSJ organization email
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Chapter CSJ organization website
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Chapter CSJ Facebook page
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Chapter CSJ Twitter account
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Chapter CSJ Additional Social Media
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Contact Person Name (Typically the chapter president or faculty advisor): *
Your answer
Contact Person Address: *
Your answer
Contact Person Email Address *
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Contact Person Phone Number *
Your answer
Contact Person University Name: *
Your answer
Contact Person Title or Role *
Your answer
We will share your CSJ chapter name, website, email and social media, and contact person's name and email address on our CSJ national website. If you do NOT want this shared, please indicate here:
Your answer
Officer Titles and Names (titles should match your constitution) *
Your answer
Current Number of Members (we recommend at least 5 to start a chapter) *
Your answer
Have you arranged a bank account? *
Required
Areas of Emphasis Available Through Program (e.g., School Counseling, Clinical Mental Health Counseling)
Your answer
Degree Programs Available (if applicable)
If Masters, Number of Hours
Your answer
Faculty Adviser Information Name: *
Your answer
Faculty Advisor Title: *
Your answer
Confirm Faculty Advisor is a CSJ Member (required) *
Faculty ACA or CSJ Membership Number: *
Your answer
Faculty Advisor Email Address: *
Your answer
Faculty Advisor Phone Number: *
Your answer
When do you plan to hold meetings (at least 2 per year)? *
Your answer
Completed Chapter Agreement (submit to Membership.CSJ@gmail.com with email subject line "CHAPTER APPLICATION") *
Completed Chapter Constitution (submit to Membership.CSJ@gmail.com with email subject line "CHAPTER APPLICATION") *
Thank You!
NEXT STEPS: The Membership Committee will review your application documents and forward approved applications to the CSJ Board for approval. You will be notified of approval or requests for changes via the contact person's email address. Typically, the review process takes no more than 30 days.

ANNUAL REPORT & INFORMATION UPDATE: University chapter affiliations are renewed yearly on September 30th. Your chapter should complete the ANNUAL REPORT form, which you can review on our website. You will receive a reminder about this deadline from the Membership Committee.

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