Oklahoma School Psychological Association
P.O. Box 30216
Midwest City OK 731403216 |
Fax Number: 405-330-7388
(Attention: Jami Haywood) |
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OSPA Directory Information
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| To improve communication, OSPA is in the process of developing a
database and directory of school psychologists and related professionals. The directory will consist of basic contact
information such as name, address, telephone and email address. The other information will be used for OSPA membership
mailings and membership statistics. Thank you for completing this form and please note that you can elect to provide
this information to OSPA only and not be published in the directory. Please fax or mail the completed form to the
above number or address. |
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| First Name _________________________ |
Last Name _________________________ |
| Company Name _________________________ |
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| Title _________________________ |
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| Birth Date (mm/dd/yy) __________________ |
Gender ______ |
| Address _________________________ |
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| City _________________________ |
State __________ Postal Code __________ |
| Region _________________________ |
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| Home Phone _________________________ |
Work Phone _________________________ |
| Fax Number _________________________ |
Email _________________________ |
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| Certifications: Check all that apply |
NCSP ____
School Psychologist ____
Psychometrist ____
Other Credentials _________________________ |
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| Memberships: |
OSPA Member
Regular_____ Student_____ Life_____
Associate_____ Honorary_____
NASP Member
____
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| Do Not Publish In the Directory _____ |
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