Latino Psychological Association of New Jersey

Latino Psychological Association of New Jersey

Applicant Information:

First Name:

Last Name:

Organization:

Address:

Address (continued):

City:

State:

Zip/Postal Code:

County:

Home Phone:

Email:

Website URL:

Professional Information:

Employer:

Address:

Work Phone:

Fax:

Title:

Highest Level of Degree:

School:

Title of Dissertation:

Currently in Private Practice?

YesNo

Are You Licensed?

YesNo

Area(s) of Expertise Includes:

Area(s) of Interest Include:

Send Mail to:

HomeOffice

Do you want to be
listed in the LPANJ
Membership Directory?:

YesNo

Do you want to be included
in an internet listserve?:

YesNo

Select Membership Level:

FULL MEMBER: Any individual who possesses a bachelors, masters or doctoral degree in psychology and is committed to advancing the field of Latino psychology. Full Members may vote on all matters and hold certain offices. Doctoral-level members and master-level members with three years of board experience may serve as president-elect, president or past-president.
Annual dues: $60

AFFILIATE: Any individual who is committed to advancing the field of Latino psychology, but who does not meet the requirements for Full Membership (e.g., social work, counseling, psychiatry, nursing). Affiliate members enjoy all the benefits of full membership; however they may neither vote nor hold office, but may serve on committees.
Annual dues: $40

STUDENT: Any individual currently enrolled in an undergraduate or graduate program in psychology or a related discipline and who is committed to advancing the field of Latino psychology. Undergraduate student members may neither vote nor hold office, but may serve on committees, while graduate students may vote and hold certain offices.
Annual dues: $25

I HEREBY CERTIFY THAT THE FOREGOING STATEMENTS MADE BY ME ARE TRUE.