National Organization of Forensic Social Work

Membership Application

If you have any questions about this application, you can contact Jim Campbell at jim.campbell@nofsw.org or call 608.561.2997. You can exit from the partially completed application form and come back to it later.

Personal Information

First Name *

Middle Initial

Last Name *

Suffix

Degree and License Abbreviations (for example: Mary Smith, PhD, LCSW)

Home Address

City

State

Zip Code

Country

Home or Cell Phone

Employer (or school if full-time student)

Work Address

0/150 characters

City

State

Zip Code

Country

Work Phone

Mail correspondence to: *

Home Address

Work Address

Email Address *

Academic Background (list degrees, academic institutions and year graduated) or upload CV/resume.

Upload Resume or CV

Current Position Title *

Date started position

Areas of Practice

Current professional license

License Number

State or issuing agency

If your license has ever been revoked, or if you have been disciplined by the licensing agency, please describe below.

0/500 characters

Membership

Membership Categories:

Full Member MSW and three years post-graduate forensic social work experience ($125.00 per year)

Associate Member Less than three years Forensic social workers without MSW or three years forensic social work experience. ($115 per year)

Allied Professional Member Professional interest in Forensic Social Work but practicing in a profession other than social work ($115 per year)

Student Member Full-time social work student ($40 per year)

Retired Member Retired social work practitioner ($50 per year)

Organizational Member (organizations can apply up to 10 memberships to staff) ($1000 per year)

Select Membership Cateogory *

Proof of student Membership Eligibility (copy of class schedule or other proof of registration at school)

Payment (The NOFSW membership year is January through December). *

$1000 for Organizational Membership

$125 for Full Membership

$115 for Associate or Allied Membership

$50 for Retired Membership

$40 for Student Membership

Form of Payment *

Credit Card

Check or Money Order

Credit Card Number

Expiration Date (MM/YY)

Credit Card Validation Number

Name on Credit Card

Billing Address

City

State

Zip Code

Certification

I agree to abide by the NOFSW Code of Ethics (or for Allied members - their own discipline's code of ethics) in my professional practice. *

I agree.

Addictions Prevention/Treatment	Adoption & Foster Care
Advocacy Consulting and Planning	Child Abuse & Neglect
Child Welfare Services	Chronic Pain
Community Mental Health	Community-Based Services
Criminal Justice	Crisis Intervention
Depression	Development Disabilities
Difficulties in School	Disaster Relief
Domestic Violence	Eating Disorders
Employee Assistance	Employment Services
Family Planning	Family Preservation Services
Genetics Gerontology Services	HIV/AIDS
Homless Family Assistance	Hospice and Pallative Care
Hospital Social Work	Housing Assistance
In-Home Services	Institutional Care
International Social Work	Mental Health Therapy
Military Social Work	Outpatient Treatment
Parent Education	Political Development
Private Practice	Public Welfare
Rural Social Work	School Alternative Programs
School Violence	Senile Dementia & Alzheimers
University Educator	Veterans Services Veterans Services