Membership application
This is NOT an on line form. Please print this form and then fill in the information requested and then mail it with your payment or P.O. to the OAPSA treasurer (see "Officers" page for current address).
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Name: __________________________________________________
Position Title: ____________________________________
School District: ___________________________________
Street Address: ____________________________________________
City: _____________________ State: ____ Zip: __________________
Office Phone : ___________________ Office Fax: ________________
Home Phone: ________________ E-Mail Address: ________________
Check areas of responsibility:
| ___ | Attendance/Student Accounting | ___ | School Social Work |
| ___ | Exceptional/Special Education | ___ | Speech and Language Services |
| ___ | School Psychology | ___ | Guidance |
| ___ | Pupil Appraisal | ___ | Discipline |
| ___ | Gifted/Talented Programs | ___ | Nursing |
| ___ | State or Federal Grants | ___ | At-Risk Program |
Included with my payment/P.O. are the following annual dues:
| ___ | OAPSA $55.00 | ___ | OAPSA/NAPSA Joint Membership $180.00* |
*$135 dues for NAPSA (National Organization) will be reduced to $125 with joint membership dues. OAPSA will process your national application.
NEW MEMBERS:
I certify that the above-named applicant is officially designated as having current district-wide administrative responsibility for the services checked.
___________________________________________________
Superintendent's Signature
___________________________________________________
Applicant’s Signature
Please print and submit this form by mail.
