Cape & Islands School Counselor Association Membership Application

Please type your name *

Your answer

Title

Your answer

School Name

Your answer

Address *

Your answer

Work Phone Number

Your answer

Fax Number

Your answer

Personal Phone Number *

Your answer

Email Address *

Your answer

Membership Type *

Professional Membership—licensed guidance, college, and independent counselors and official admissions representatives from public and private secondary and post-secondary schools, colleges and universities, employed in a full-time or part-time capacity ($25.00)

Associate Membership—licensed counselors who are not currently employed in the field, school/guidance counselor interns who are enrolled in a degree program leading towards licensure in school guidance and counseling ($20.00)

Honorary Life Membership—retired CISCA members (no fee)

New members: please indicate who has referred you to CISCA

Your answer

Interns: please give the name of your current supervisor

Your answer

Submit

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service

Forms