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@counseling-csj.org

Additional guidelines and examples are available on the CSJ website: www.counseling-csj.org/start-a-chapter

Email address *
Chapter CSJ Information
Organization name *
Your answer
Organization email
Your answer
Organization website
Your answer
Organization Facebook page
Your answer
Organization Twitter account
Your answer
Organization Additional Social Media
Your answer
Contact Person
Typically the chapter president or faculty advisor
Contact Person Name *
Your answer
Contact Person Address *
Your answer
Contact Person Email Address *
Your answer
Contact Person Phone Number *
Your answer
Contact Person University *
Your answer
Contact Person Title or Role *
Your answer
Additional Information
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. Please indicate here if you do not want this information shared. *
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
When do you plan to hold meetings? *
University Chapters must hold at least 2 per year
Your answer
Have you arranged a bank account? *
Areas of Emphasis Available Through Program
Degree Programs Available (if applicable)
If Masters, Number of Hours
Your answer
Faculty Advisor Information
Faculty Advisor Name *
Your answer
Faculty Advisor Title *
Your answer
Confirm Faculty Advisor is a CSJ Member *
Faculty Advisor ACA or CSJ Membership Number *
Your answer
Faculty Advisor Email Address *
Your answer
Faculty Advisor Phone Number *
Your answer
Please acknowledge that you will email the following to Membership@counseling-csj.org:
Completed Chapter Agreement (email subject line "CHAPTER APPLICATION") *
Completed Chapter Constitution (email subject line "CHAPTER APPLICATION")
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