Membership

 SCPEN.NET   South Carolina Parenting Education Network
.SCPEN.NET
South Carolina Parenting Education Network

                                                                 SCPEN Membership Application  SEE LINK BELOW FOR FORM 


   First Name_______________________MI____Last Name_______________________________
  Address_______________________________________________________________________
 City/State____________________________________________________Zip_______________
  Home/Work Phone___________________________Cell/Mobile Phone____________________
  Email Address__________________________________________________________________

                                                                          Personal Information:
                                          Please check the professional fields in which you work:

       ___ Parenting Education___ Adult Education ___ Youth Development ___ Early Childhood 

       ___ Family Social Science___ Counseling ___ Social Work___ Health ___ Psychology

       ___ Family LIfe________Other__________________________


                                                        Please check your highest level of education:

      ___ High School Diploma/GED___  Associate Degree___ College Bachelor Degree (BA/BS)

      ___ Masters Degree (MA/MS/MEd.)___ PHD___ Other _______________________

      ___No degree but practical experience (in what and howmuch)________________________

          Languages Spoken (Any Fluently)______________________________________________

          List all certificates/licenses held:    ______________________________________________

                                                                            _____________________________________________ 


                                                      Type of Membership: May check one or both.

          ___Family Services Provider

          ___Program  Facilitator

                                                                                    SCPEN
                                                      is an educational servce of still learning, inc.                
                                                              MEMBERSHIP APPLICATION PAGE 1


                                                    SCPEN MEMBERSHIP APPLICATION  (Page 2)


        Personal Statements
        Answer each question with a minimum of 25 words and a maximum of 200 words.

                                           (1)Why do you think parenting education is important?









                                               (2)Why do you want to be a member of SCPEN? 








        I certify that the information provided is correct to the best of my knowledge.  If my applications 
                approved for membership in SCPEN I understand that it is conditionally based upon          
        supplying a $25 yearly membership fee and abiding by the guidelines set forth by SCPEN.  
        While SCPEN does not endorse specific programs the listing as a member on SCPEN websites            an acknowledgement of you and your work being accepted as helping to advance the field  
                                                                           of parenting education.


         Signature_________________________________________________Date_______

                   PLEASE CLICK HERE 



                       TO LINK TO APPLICATION.  FILL IT OUT, PRINT IT. CLOSE IT.  
                                                         SAY NO TO CHANGES.
                                 MAIL OR SCAN AND EMAIL AS AN ATTACHMENT TO 


SCPEN
 still learning, inc. po box 14028, surfside beach, sc 29587
www.stilllearning.org, ParentsCare@sc.rr.com


SCPEN_MEMBERSHIP_FORM_2_PAGES.doc
SCPEN_MEMBERSHIP_FORM_2_PAGES.doc