• Find A Psychologist
  • Log In
  • Video Library
  • Ads & Opportunities
0 Items
Connecticut Psychological Association
  • Home
  • Find A Psychologist
    • Mental Health Providers of Color Directory
    • Workers’ Compensation Commission – Pain Management Protocol Trained Providers
  • About
    • CPA Board of Directors
      • Current Leadership
        • Board Responsibilities
        • Bylaws
    • Equity Diversity Inclusion
      • Ethnic Diversity Task Force
      • Social Justice Series
    • Divisions & Committees
      • Student Division
      • Early Career Division
      • Neuropsychology Division
      • Forensic Division
      • Special Interest Groups
      • Fellows
    • Central Office
    • History
      • Presidents
      • Milestones
    • CPA Educational Foundation
  • Professional Resources
    • Licensing Info
    • Ads & Opportunities
  • Advocacy
    • Legislative Advocacy Fellow
    • CPA Legislative Committee
    • Find Your Legislators
    • The Catherine Acuff Awards
  • Membership
  • Public Resources
    • Find A Psychologist
  • Media
    • Updates & Communications
    • CPA In The News
    • President’s Column
  • Events
    • Annual Convention
  • Contact Us
Select Page

by Marla.lardiere | May 7, 2020

Price:
Free
First Name Required
Last Name Required
Prefix is not valid
E-mail is Required
Primary Phone is Required
Cell is not valid
Fax is not valid
Gender: (By inviting members to self-report their gender identify (diversity data), CPA facilitates an evidence-based approach to advancing equity, diversity, and inclusion (EDI). By analyzing diversity data, CPA aims to increase diversity and inclusion in our community, organizational processes, remediate unfair bias, and drive greater equity in psychology more broadly.) is Required
Birth Date is Required
Ethnicity: (By inviting members to self-report their ethnic origins and race (diversity data), CPA facilitates an evidence-based approach to advancing equity, diversity, and inclusion (EDI). By analyzing diversity data, CPA aims to increase diversity and inclusion in our community, organizational processes, remediate unfair bias, and drive greater equity in psychology more broadly.) is Required
If Biracial/Multi-ethnic/Other please specify is not valid
Home Address is not valid
Home City is not valid
Home State is not valid
Home Zipcode is not valid
Home Telephone is not valid
Business name (or college) is Required
Website is not valid
Work Address is not valid
Work City is not valid
Work State is not valid
Work Zipcode is not valid
Work Telephone is not valid
Work Telephone Extension is not valid
Work Fax is not valid
Check address you wish used for CPA mailing is Required
Year joined CPA (approx. OK) is not valid
Highest Earned Degree
Note: If your highest degree was NOT granted by a department of psychology, AND you are not a member of the American Psychological Association, please include a transcript (official or student copy) of your graduate work. is Required
Institution is Required
Graduation Year is Required
Location of Institution is Required
Department is Required
Program is Required
States in which you are licensed or certified as a psychologist, including license/certificate #s is Required
Have you ever been convicted of a felony? is Required
If yes, provide conviction details. is not valid
Do you have an ethics violation charge pending anywhere, or have you ever been charged with a legal ethical violation? is Required
If yes, provide ethics violation details. is not valid
How many years, exclusive of training positions, have you been employed/practiced in the field of Psychology? is Required
Title/Position and Employer is Required
Immediate Supervisor is Required
% Time is Required
Since (yr.) is Required
Previous Title/Position and Employer is not valid
Previous Immediate Supervisor is not valid
Work Setting is not valid
If you are NOT licensed as a psychologist in Connecticut, AND are NOT an APA member (in the same category for which you are applying for CPA membership), we ask you to provide endorsements from two members of CPA, or one member of CPA and one member of APA. Please list the names and addresses of the individuals to whom you have given the enclosed endorsement forms. If you are not sufficiently familiar with two people who can endorse you, contact the CPA Central Office. is not valid
Reference 1 Address is not valid
Reference 2 Address is not valid
Check below if: is not valid
Forensic Division - Additional Membership Price $50.00 (USD) is not valid
Neuropsychology Division - Additional Membership Price $0.00 (USD) is not valid
Health Psychology Division - Additional Membership Price $0.00 (USD) is not valid
Areas of Interest is not valid
Present membership status in APA is Required
Year joined APA (approx. OK) is not valid
Institution in which enrolled is Required
Year entered is Required
Certified Full-Time Student is Required
Major Field is Required
Degree Expected is Required
Student Affiliate of APA? is Required
Applicants for Student Affiliate status who are NOT Student Affiliates of APA are asked to provide one sponsor's endorsement from a member of CPA. If there are no members at your institution, please request sponsorship from the chairperson of your department. Please list your sponsor's name and address here: is not valid
I hereby certify that the statements made in this application are true and to the best of my knowledge and belief I am making voluntary application to the Connecticut Psychological Association for membership in the category indicated. I agree to be bound by the Ethical Principles of Psychologists, the Standards for Providers of Psychological Services, and other standards of professional ethics and practice adopted and published by the American Psychological Association or the Connecticut Psychological Association. I agree to be bound by the Constitution of the Connecticut Psychological Association as it is applicable to me as a member or affiliate. I authorize, whenever it may be deemed appropriate by CPA, the exchange of information concerning my application (before or at any time after action is taken on my application) with the American Psychological Association, other state psychological associations, or state licensing or certifying authorities. I authorize CPA to make inquiries as it deems appropriate in connection with this application for membership, with other individuals, agencies, organizations, or other reference sources as may be appropriate, and I authorize and invite anyone so contacted to respond freely and report fully and frankly any matter which may seem relevant to my application for membership in CPA.

Enter Name is Required
Today's Date is not valid
Invalid Username
Invalid Email
Invalid Password
Password Confirmation Doesn't Match
Password Strength
 
Loading... Please fix the errors above

Your Subscriptions

  • You are not logged in.

Connecticut Psychological Association

PO Box 915

North Haven, CT 06473

(860) 404-0333

info@connpsych.org 

© 2020 Connecticut Psychological Association | Designed By: Eland Consulting