Summit 2008
Annapolis Coalition








American College of Mental Health Administration
Membership Application

Please provide the following contact information:

  1. Personal Information
Prefix
First Name
M.I.
Last Name
Credentials
Home Address
(Address 2)
City
State/Province
Zip/Postal Code
Country
Home Phone
FAX
  E-mail *
  Send College Materials to Home Address

* Note: The majority of our communication is done electronically. Please be sure to provide either a business or personal eMail address.
  1. Professional Information
Position Title
Organization
Business Address
(Address 2)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
  E-mail *
URL
Send College Materials to Business Address
 

  1. Professional Credentials/Interests

Please provide a vitae or resume that describe your professional experience and interests. This section should include:

  • Prior Positions (Include dates and relevance to Mental Health leadership and administration)
  • Other Positions (i.e., not related directly to Mental Health Administration)
  • Major Educational Credentials (include all graduate level studies and degrees)
  • Honors and/or professional recognition

If you have your vitae or resume in electronic format (e.g. Word, WordPerfect, or a Rich Text Format document), open your document in your word processing program, choose "Select All," then "Copy". Next place your cursor in the window provided below and "Paste" your document into the space provided. (Please note: you will not be able to see the entire document you have pasted into the window and formatting that you have in your resume may not be maintained).

 
  1. Interest/Involvement in the Field

Please provide a description of your interest, commitment, or contribution to the core issues of mental heath, substance abuse, consumer leadership, or administration. Areas of expertise and special interest may also be noted.

  1. Additional Information

How did you learn about the college? If you learned of ACMHA from a current member, please indicate the member's name.

 

Why are you interested in membership?

 

Which of the ACMHA initiatives or activities seem of particular interest to you?

 

Please provide the name and contact information for a reference who can offer information on your interests and accomplishments.


Please check here if you would like to talk to an ACMHA member to get additional information about being a member of ACMHA.
 



 
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