AIS Membership Application Certified Intervention Professional (CIP) Certification is Required for Full Membership Certified Intervention Professional (CIP) YesNo 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. Step 1 Complete the application above click Submit and proceed to Step 2 Step 2 Code of Ethics If you would like to complete this process thru the mail please download the application here. PDF