Membership Application

This form will take approximately 5-10 minutes to complete

Please have the following documents/information readily available:

  1. Info item one
  2. Info item two
  3. Info item three

Application Number: 123456

= Required = Optional

Ethics
Has your license to practice ever been revoked or suspended?
Are you currently charged with illegal or unethical professional conduct by a regulatory or law enforcement agency or by a professional society?
Have you ever been found guilty of illegal or unethical professional conduct by a regulatory or law enforcement agency or by a professional society?

If YES, to any of the three preceding questions, please furnish details in a confidential communication to the APA Membership Committee Chair and e-mail (in a PDF or jpg file) a copy to us at membership@psych.org or fax a copy to us at 01.703.907.1085, within 2 weeks of submitting this application.

PreviousContinue