தமிழ்நாடுஉளவியல்சங்கம்
TAMILNADU PSYCHOLOGY ASSOCIATION
(Registered under The Tamil Nadu Societies Act, 1975 Vide Reg. No. 121/2014)
_________________________________________________________________________________________________
APPLICATION FORM FOR FOR OFFICE USE ONLY
MEMBERSHIP REGISTRATION Reg. No.: ______________
Please read all the following information carefully,Especially Page No 3 Reg. Date: _____________
Please use CAPITAL Letters to fill in this Form. Fees Paid: _____________
• Fill complete address with pin-code in both present and permanent address.
Mode of Payment:
• Students applying for registration should invariably enclose a certificate about their DD/CHQ/NEFT/IMPS/Cash
Bonafidestudentship from the competent authority of the department.
• Membership Fees will be accepted if paid via Demand Draft, NEFT or IMPS. Type of Membership:
a) Life Member
• Money order, I.P.O. and Cheque will not be accepted.
b) Associate /Student
• See the membership types and fees on Page No. 2.
___________________________________________________________________________________________________________________
FULL NAME : ________________________________________________
FATHER / : ________________________________________________ Passport
HUSBAND NAME
Size
DATE OF BIRTH : _______________________ BLOOD GROUP: __________
Photo
GENDER : MALE / FEMALE MARITAL STATUS: Married/Unmarried
EDUCATIONAL : ________________________________________________
QUALIFICATION
PRESENT : _______________________________________________________________
ADDRESS
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
PERMANENT : _______________________________________________________________
ADDRESS
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
MOBILE NUMBER : 1. _______________________________ 2. ____________________________
EMAIL ID : _______________________________________________________________
IF STUDENT / RESEARCH SCHOLAR / PROFESSION
a) NAME OF THE INSTITUTION : _____________________________________________
b) DEGREE PROGRAM : _____________________________________________
IF TEACHING STAFF / OTHERS
a) NAME OF THE INSTITUTION : _____________________________________________
b) DESIGNATION : _____________________________________________
c) ID / MEMBER NO : _____________________________________________
DECLARATION
I/We ___________________________________, the applicant, hereby declare that what is
stated above is true to the best of my/our information and belief.
____________________________
SIGNATURE OF THE APPLICANT
Copies of following documents to be enclosed along with the application form:
Applicant Any One ID Proof (Self-Attested)
Student / Staff ID card (Self-Attested)
Qualification Certificate (Self-Attested) Xerox
Membership Fee Payment Receipt
Send the filled in application Scan Copy form by email
[email protected]
BANK DETAILS FOR PAYMENT:
Mode of Payment Particulars
ACCOUNT NAME : TAMILNADU PSYCHOLOGY ASSOCIATION
• NEFT/RTGS ACCOUNT NO : 06200210000779
• IMPS BANK NAME : UCO BANK
• Cash Deposit BRANCH : CUDDALORE
IFSC CODE : UCBA0000620
• Demand Draft Should be drawn in favour of “TAMILNADU PSYCHOLOGY ASSOCIATION”
TNPA MEMBERSHIP REGISTRATION TYPES AND FEE DETAILS
Student &
Life Associate Life
Scholars
Membership Membership
Membership
Rs. 2000 Rs.1000.00 Rs. 2,000.00
Office Address: No: 87, Theruveethi Amman Kovil Street, Theruverkadu Post, Noombal,Chennai– 600 077
Web: www.tnpsya.org Email: [email protected] Mob: + 91 9488494881
Instructions for membership;
The following are the terms & conditions for the membership of Tamilnadu Psychology Association:-
1) The registration as a member with this association is only for the purpose of enhancing one's
knowledge of psychology. As such this association is not authorized to issue license for starting
counselling centers.
Further this association will not be responsible for any violation of law by an individual or individuals.
2) Once you register as a member your membership certificate will reach your residential address in
three months time.
3) If you want to register as a member you have to first e-mail your educational qualification
certificates to the e-mail address of this association.After verification only after we permit you to pay
the membership fees you have to deposit the membership fees.If you pay the fees without our
permission we will not be responsible for refund.
4) If your conduct is in violation of the rules & regulations of this Association your membership will be
canceled and membership fee will not be refunded.
5) Members are required to comply with the rules and regulations of the tamilnadu psychology
association
Types of Membership
1) Life Membership;
Under graduation in Applied Psychology with Master degree ,including the specializations such
as clinical psychology,counseling psychology,HRM psychology ,in regular mode will be considered as
a Life Member in TNPA
2) Student / Scholars Membership;
Students who completed under graduation in applied psychology ,and perusing Masters degree
in psychology in regular mode including any branch of psychology can enroll as student member in
TNPA.
The students member should enroll themselves as a life member ,once they complete their post
graduation ,the concession will be given to enroll as a life member.
3) Associate Membership;
Master degree in psychology with any area of specialization in psychology through distance mode will
be considered as an associate member in TNPA.
Master degree with any one paper in psychology including any one of the branch of
psychology ,including Counselling & Psychotherapy, B,Ed Special education,Master of Social
Work,Education, Philosophy, are considered as an associate Member in TNPA.
Thanking You
By President
