CCPA Student
Representative Application
CCPA_POS_09_2019
Please note that this form must accompany a membership application form
in order for your membership to be processed.
CCPA has a Student Representative program at Universities that offer master’s-level degrees in
counselling or related fields leading to certification.
These Student Reps are available to contact if you have any questions about CCPA, its membership,
and/or the profession. CCPA Student Reps act as liaison and facilitate communication between the
University, its students, the appropriate Provincial Director and CCPA. They engage in activities
intended to inform students about the Association and the counselling profession. CCPA encourages
and supports Student Reps to be actively involved with the students on campus, with the CCPA
National Conference, and with CCPA’s Student Newsletter.
Why do you wish to become a CCPA Student Representative?
Name:
University:
Date:
Phone Number:
EMAIL:
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: adminasst@ccpa-accp.ca
Signature
click to sign
signature
click to edit
![]()
