Allegheny County School Counselors Association Membership Registration 2022-2023

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Thank you for your interest in joining this professional community of school counselors and related professionals from Allegheny County. Please complete the form below. **PAYMENT CAN BE MADE VIA PAYPAL OR CHECK** Membership dues at renewed EACH school year.

Please pay membership here before finishing this form if paying via Paypal. **PLEASE be sure your first and last name match Paypal AND. Membership Registration form - otherwise email us and let us know ASAP!

Email *

Last Name *

First Name *

Your PPID Number (if you do not provide this, you will not be able to earn credit for ACT 48 hours for professional development- if you do not have one please write "none") *

Title

Example: School counselor, director of counseling, OVR coordinator, social worker, dean, etc...

School District or Organization *

Building Name *

Mailing Address Line 1 *

Mailing Address Line 2

City *

State *

Zip Code *

Preferred Email Address for ACSCA Communications *

Preferred Contact Telephone Number *

1st Time Members: Did a current ACSCA member tell you about ACSCA? If so, list who below..

At what type of institution are you employed? *

Please note that our organization encourages membership from a wide variety of stakeholders. However in order to be a Professional, and therefore voting member, you must be employed as a school counselor in Allegheny County. Non-Allegheny counselors are welcome to join as Associate members.

Public school district (Professional Member if in Allegheny County)

Public school: Cyber-charter (Professional member if in Allegheny County)

Public school: Charter (Professional member in in Allegheny County)

Private school: Parochial or otherwise (Professional member if in Allegheny County)

Counselor Educator (Professional member)

Community organization (Associate member)

Governmental organization (Associate member)

I am currently retired (Retired member)

I am not currently employed. (Regular member)

I am a Lifetime member of ACSCA.(Regular member)

Membership Level at which you will be joining the organization? *

Professional-$25

Regular-$25

Associate-$25

Student-$15

Retired-$15

Level (Check all that apply) *

Please indicate which level(s) of students you work with.

Pre-K

Elementary

Middle School/Junior High

High School

Post-Secondary

Other

Required

Should you agree by providing the information below, our organization would like to contact your supervisor to alert them of your membership in this organization. For school counselors, this is an important part of meeting the Danielson model for school counselor evaluation. Please provide your supervisors FULL NAME, including Dr/Mrs/Mr/etc.

Supervisor's Email

Are you interested in possibly joining the ACSCA leadership team in any way? (committee chairperson, executive board, etc.)

Yes

Maybe

Not at this time

Clear selection

Please pay membership BEFORE submitting form online. To pay via Paypal: www.PayPal.Me/ACSCADues *

Paypal *PLEASE BE SURE YOUR LAST NAME MATCHES YOUR MEMBER REGISTRATION FORM*

Check (please email us for address acscaofpa@gmail.com)

Other:

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