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    Membership

        South Carolina Parenting Education Network
    .
    South Carolina Parenting Education Network

                                                                     SCPEN Membership Application  SEE LINK BELOW FOR FORM 


       First Name_______________________MI____Last Name_______________________________
      Address_______________________________________________________________________
     City/State____________________________________________________Zip_______________
      中国福利彩票下载安全/Work Phone___________________________Cell Phone____________________
      Email Address__________________________________________________________________

                                                                              Personal Information:
                                              Please check the professional fields in which you中国福利彩票下载安全 work:

           ___ Parenting Education___ Adult Education ___ Youth Development ___ Early Childhood 

           ___ Family Social Science___ Counseling ___ Social Work___ Health ___ Psychology

           ___ Family LIfe________Other__________________________


                                                            Please check you中国福利彩票下载安全r 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 how much)________________________

              Languages Spoken (Any Fluently)______________________________________________

              List all certificates/licenses held:    ______________________________________________

                                                                                _____________________________________________ 


                                                          Type of Membership: May check one or both.

              ___Family 中国福利彩票下载安全 Provider

              ___Program  Facilitator

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


                                                        SCPEN MEMBERSHIP APPLICATION  (Page 2)


            Personal Statements


                                                     Please give at least 25 words, or more in answering.

                                                   (1) Why do you中国福利彩票下载安全 think parenting education is important?











                                                   (2) Why do you中国福利彩票下载安全 want to be a member of SCPEN? 










                           I certify that the information provided is correct to the best of my knowledge.  
            While SCPEN does not endorse specific programs the listing as a member on SCPEN websites           is an acknowledgement of you中国福利彩票下载安全 and you中国福利彩票下载安全r work being accepted as helping to advance the field  
                                                                               of parenting education.




             Signature_________________________________________________Date_______

                        and