Membership Form - The North Carolina College Personnel Association

NCCPA Membership Form

Name *

First

Last

Job Title *

Institution *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Are you a first-time NCCPA member? *

Membership Fee *

Student ($21)
Professional/Faculty ($26)

Are you a member of ACPA-College Student Educators International? *

Yes
No

Were you referred to NCCPA by another member? If yes, who? *

The following information is being requested by ACPA-College Student Educators International to further enhance programs, practices
and services to meet member needs. Regarding the collection of this information from our members:

Each question enables ACPA to analyze and understand the unique feedback and ideas of members.
Individual identities will not be shared without the indicated consent from the respondent.
Each question’s response options have been listed to reflect the Association’s value on inclusion of member identities and to minimize unintended micro-aggressions.
Given the scope and complexities of social identities that exist worldwide, and acknowledging the limitations of existing data gathering capabilities, response options listed in the following questions are rooted in U.S. historical and cultural contexts.

OPTIONAL: How do you describe your gender identity? Your response to this question will assist ACPA in advising future program opportunities and to provide more specific response options in future assessments. *

OPTIONAL: How do you describe your racial identity? Your response to this question will assist ACPA in advising future program opportunities and to provide more specific response options in future assessments. *

OPTIONAL: How do you describe your sexual identity? Your response to this question will assist ACPA in advising future program opportunities and to provide more specific response options in future assessments. *

OPTIONAL: Do you have a long-lasting or chronic condition (physical, visual, auditory, cognitive or mental, emotional, or other) that substantially limits one or more of your major life activities (your ability to see, hear, or speak; to learn, remember, or concentrate)? *

Yes
No
Prefer Not To Answer

OPTIONAL: Do you identify as a military veteran or service member? *

Yes
No
Prefer Not To Answer

If Yes, please indicate the terms that best describes your experience (select as many as apply): *

U.S. military veteran or active duty member
Military veteran or active duty member in a country other than the U.S
Current or former member of the U.S. National Guard or Reserves
Current or former member of the National Guard or Reserves or similar in a country other than the U.S.
Prefer not to answer

Submit