APPIC

Create a New Program Account

Programs seeking membership for their programs are required to complete the following Registration Form.
You may not continue with the application process until all fields have been completed and the form has been submitted.

Select a Role

Training Director/Director of Clinical Training (DCT) Psychology Lead/Chief/Department Chair

This registration process is intended for Academic and Training programs interested in obtaining APPIC Membership. It is not intended for individual registration. If you represent a program seeking APPIC membership, please continue with the registration process. If you have any questions, please use the contact information found on the APPIC Central Office website: http://www.appic.org/contact.aspx.

Registration is intended for programs interested in APPIC Membership . It is not intended for individual registration. If you are not registering a program, go to www.appic.org for alternate information.

Are you a Training Director or Psychology Lead/Chief/Department Chair for an Institution/Site wishing to pursue membership?

Yes No

Institution Details

Agency/Institution Name

Department Name

Academic or Training Program Academic Training

Program Type Internship Post Doctoral Clinical Counseling School Combined Other

Membership Type Provisional Membership Full Membership

Degree Type

Match Fee Level

Program Category

American Psychological Association (APA) Accreditation Accredited Not Accredited

Site Visit Authorized

Please forward a copy of the site visit authorization to APPIC at appic@appic.org

Accredited, On Probation Accredited, Inactive Accredited on Contingency

Year of APA Accreditation

Canadian Psychological Association (CPA) Accreditation Accredited Not Accredited

Site Visit Authorized

Please forward a copy of the site visit authorization to APPIC at appic@appic.org

Accredited, On Probation Accredited, Inactive Accredited on Contingency

Year of Initial CPA Accreditation

Psychological Clinical Science Accreditation System (PCSAS) Accreditation Accredited Not Accredited Site Visit Authorized

Year of Initital PCSAS Accreditation

Please forward a copy of the site visit authorization to APPIC at appic@appic.org

Program Organization Type Consortium Individual

Address

Web Address

User and Login Details

Name

Phone

Ext.

Fax

Ext.

Email Confirm Email

Password

Password must be between 6-20 characters.

Registration is intended for programs interested in pursuing accreditation of an educational program in academic or training. It is not intended for individual registration. If you are not registering a program, go to www.APPIC.org for the agency site and alternate information.