MiPSAC Membership Information

There are two ways to become a member of MiPSAC, the state chapter of APSAC.

Joining APSAC (apply at www.apsac.org) and paying your annual APSAC dues makes you a member of MiPSAC if your membership address is in Michigan. A portion of your APSAC membership fee is sent to MiPSAC to cover your membership to MiPSAC.

Our changed bylaws have created an in-state membership category to join MiPSAC–this does NOT include APSAC membership. You may become a MiPSAC member without joining APSAC by submitting the information below. If all qualifications are met and you are approved for MiPSAC membership, you will receive an e-mail requesting payment of annual MiPSAC membership dues of $25.

If you have questions, please contact the MiPSAC membership chair, Dena Nazer, at dnazer@med.wayne.edu.

Your Name (required)

Degree (required)

Job Title (required)

Preferred Mailing Address (required)
 Work Home

AGENCY INFORMATION

Agency Name (required)

Agency Street Address (required)

Agency City (required)

Agency State (required)

Agency Zip (required)

Agency Office Phone Number (required)

Agency Fax Number (required)

Agency Email (required)

HOME ADDRESS

Street Address

City

State

Zip

FIELD OF PRACTICE

Please indicate one item from each of the drop down options to indicate the best description of your work.

DISCIPLINE

Discipline Option 1

Discipline Option 2

Other Discipline, if not included above

FUNCTION

Function Option 1

Function Option 2

Other Function, if not included above

AREA OF EXPERTISE

Area of Expertise Option 1

Area of Expertise Option 2

Other Area of Expertise, if not included above

POPULATION SERVED

Population Served Option 1

Population Served Option 2

Population Served, if not included above

PROFESSIONAL REFERENCES

Please provide two professional references or the name of a current MiPSAC member who we may contact in order to verify the above information:


If you are entering a MiPSAC member as a reference, please enter "N/A" in the fields below.

FIRST REFERENCE

Reference Name

Reference Job Title

Reference Contact Address

Reference Email Address

Reference Phone Number

SECOND REFERENCE

Reference Name

Reference Job Title

Reference Contact Address

Reference Email Address

Reference Phone Number

If you are not submitting a MiPSAC member as a reference, please enter "N/A" in the field below.

Name of MiPSAC Member

How did you hear about MiPSAC?

PLEASE NOTE:  Individuals applying for membership must be professionals working in the field of child maltreatment or a related field.  Membership in MiPSAC does not certify professional competence.

In applying for membership, professionals certify compliance with the APSAC code of ethics (CLICK HERE TO VIEW) as well as the professional and ethical standards of and all laws and regulations relating to their respective profession or field.

I certifiy compliance:

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