AIS Membership Application

Below is the digital application, please read the form ahead of time and ensure you have all your documentation.

The form will not save your data and once you submit the data it will email us directly. At the bottom of this initial form it is imperative you digitally sign before moving on to the next step.

    Certified Intervention Professional (CIP) Certification is Required for Full Membership

    Certified Intervention Professional (CIP)


    Please check which you are applying for

    FullCandidateAssociate

    Applicant Information






    Zip Code/Postal Code

    Phone Number


    Work Experience Related to Interventions: (Where have you worked, when, what duties did you perform....)

    Training and/or educational experiences related to Interventions (attach docs)

    Style of Intervention (brief statement of philosophy)

    Types of interventions offered – (AOD, Eating Disorders, Sexual Trauma, Gambling, etc....)

    Geographical Locations (areas where you will facilitate interventions)

    Other Services Offered

    Credentials (Degrees, Licenses, certifications including first year received) Attach copies

    AIS Membership Application

    References












    Personal Statement

    Verification

    Digital Signature of Applicant: *

    I authorize the verification of the information provided on this form as to my credit and employment.

    By submitting the above information, I am submitting my application for consideration as a member of AIS.

    Step 1: Almost Completed

    By submitting the above information, I am submitting my application for consideration as a member of AIS.

    Step 2: I am now ready to move onto Step 2 and review and sign the AIS Code of Ethics.

    Take Me to The Code of Ethics

    If you would like to complete this process thru the mail please download the application here.