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New Jersey College Counseling Association
1) Fill out the form below for each individual registering for/renewing membership.
(Even if multiple people are paying together, this form must be completed for each person.)
2) Click the "Submit" button at the bottom of your completed form to be automatically taken to payment options.
Note: Should there be no response to "Submit" be sure to check for incomplete required fields (appear as red boxes).
3) Select Payment Option
-Pay online using a credit/debit card
Mail check or purchase order to address provided.
Click HERE to learn about membership
Membership runs from June 1st through May 31st of each year.
Indicates required field
$35 Professional Membership
$15 Student Membership
University Counseling Center Affiliated
Associate (Private Practice/Other Professional)
Add me to the NJCCA Members ListServe
Yes means you will receive announcements and postings by NJCCA members. You will also be eligible to post yourself.
Short description or title of your job or position at the institution where you work. For independent practice list your profession. E.g. Clinical Social Worker, Director of Counseling Services, Career Counselor, Psychologist, Graduate Student, Postdoctoral Trainee, etc.
Preferred email for correspondence.
Preferred Phone Number
Institution (University or College Name/Private Practice/Other)
List "Private Practice" or other relevant info if you do not work at a college or university.
Preferred Mailing Address
Student Members complete this section
Degree Being Sought
College or University
Program or Major
Anticipated Graduation Year
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