CCPA Student Membership
Proof of Student Status Form
CCPA_POS_09_2019
Please note that this form must accompany a membership application or
renewal form in order for your membership to be processed.
Name:
Street Address:
City, Province:
Telephone: EMAIL:
University:
Program:
Expected Graduation (MM/YY):
1. Student Information
Postal Code:
Student Membership:
In order to be eligible for a reduced fee as a student member, individuals must be presently enrolled in an
undergraduate, post-baccalaureate certificate or diploma, master's degree or doctoral program in
counselling or a related field.
By signing below, I hereby confirm that the student indicated above is enrolled in such a program and that I
am a faculty member or employee of the post-secondary institution at which the student is enrolled.
Name:
Position:
Date:
Phone Number:
EMAIL:
2. Post-Secondary Institution Approval
Please complete the form and return to:
Canadian Counselling and Psychotherapy Association
202 - 245 Menten Place
Ottawa, ON, K2H 9E8
Telephone: (613) 237-1099
Toll-Free: 1-877-765-5565
Fax: (613) 237-9786
Website: www.ccpa-accp.ca
EMAIL: membershipadmin@ccpa-accp.ca
*Signature:
click to sign
signature
click to edit
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