| Membership Type * |
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| Payment System * |
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Your Name *
Your First & Last name |
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Your E-Mail Address *
to you at this address
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Choose a Login Name (User ID) *
It must be 4 or more characters in length and may
only contain small letters, numbers, and the underscore '_' |
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Choose a Password *
Must be 4 or more characters |
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Confirm your password *
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| Preferred Address
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| Home Address
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| Home City
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| Home State
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| Home Zip Code
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| Home Phone
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| Fax
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University
(for Students/Interns only) |
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| Employer
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| Address
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| City
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| State
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| Zip Code
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| Work Phone
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| In what special education cooperative or school district is your employment located?
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| ISPA may make available at an appropriate charge, the full or partial lists of the members to certain carefully selected companies or organizations serving the fields of general and special education. Do you wish to have your name included on such lists?
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Regular Member Certification
Certification Number (For New Members Only): |
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First Year Member Certification
Certification Number: |
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Student Member Advisor's Name
Please include name, email address, and phone number of Advisor for verification purposes. |
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Intern Member Supervisor's Name
Please include name, email address, and phone number of Supervisor for verification purposes. |
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| I prefer to print a copy of my membership card on the ISPA web site. (Available after Nov 1, 2012).
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| I prefer to access a digital copy of SPII newsletter on the ISPA web site rather than receive a hard copy by mail.
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| I prefer to renew my membership online rather than receive a hard copy renewal application via mail in the future. (Email reminders will still be sent.)
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| Would you like to be assigned a mentor?
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| Would you like to be a mentor?
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| Highest Degree Earned?
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| If other degree, specify
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| Please add any additional credentials, certifications, or licenses.
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| Primary Position
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Employment Setting
(select up to 3) |
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| If Other, please specify
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| Annual Salary
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| Full or Part Time
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| Contract Length (Days)
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| School Psychology Experience
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| Psychologist to Student Ratio
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| Year of Graduation (students)
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| Are you a member of: (check all that apply)
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| Other Professional Affliations
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| Are you a Nationally Certified School Psychologist (NCSP)?
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| If yes when is your NCSP renewal?
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| Are you:
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| Language(s):
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| Do you possess the ISBE Bilingual Special Education Approval as a Bilingual School Psychologist?
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| If Yes, in what language(s)
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| By answering "yes" to this question, I agree to give ISPA permission to publish my name and email address as a Bilingual School Psychologist in electronic format on its website. By selecting either yes or no and entering today’s date, I verify that the information on this item is true, complete, and accurate.
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| ISBE Agree Date
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| Would you be willing to speak at an ISPA workshop or be listed in our Speakers' Bureau?
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| If so, list topic(s)
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| Your Age
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| Gender
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| Race/Ethnicity:
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| If other race/ethnicity, specify
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| Join ISPA Committee?
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| Please indicate if you would be interested in joining or learning more about the following ISPA committees:
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Your membership card may also be printed (or is also available) from your 'edit profile' menu.
Based on our accounting, the Illinois School Psychologists Association estimates that 6% of your dues are for lobbying expenses, which are non-deductible. Check with your accountant on the balance of your ISPA membership dues to determine their deductibility.