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

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

Address

Web Address

User and Login Details

Name

Phone

Ext.

Fax

Ext.

Email Confirm Email

Password

Password must be between 6-20 characters.