Member Survey – Student

Welcome Student Member!

Thank you for supporting the Society of Clinical Psychology. To enhance our membership benefits, we are requesting that members fill out their profile in full. This will help the Division to gather appropriate data to provide you with the best benefits. You will be able to access all other areas of the website, once your profile is submitted. Thank you and please feel free to email the Central Office at division12apa@gmail.com if you have any questions.

* Denotes Required Field

Student Membership Survey

Personal Information

Application Type *

Mailing Address *

City *

State/Province *

Zip/Postal Code *

Country *

Phone Number

FAX Number

Home Phone Number

Age *

Gender *

Student Information

Type of Student *

Institution Now Attending *

University *

Expected Graduation Year *

Professional Setting *

Subtype of Clinical Psychology * Subtype of Clinical Psychology

Other Information

Name of the person who referred you to Division 12 (if applicable)

Email of the person who referred you to Division 12 (if applicable)

Do you want to be added to the Div12 Announcement Listserv? *

Yes

Do you want to be added to the Div12 Interactive/Discussion Listserv? *

Yes

One of the primary reasons I joined D 12 at this time was to take advantage of the no cost CE offerings. *

Yes