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Virginia State Membership Form
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 You may  Download Application Form.  or use the following:


Virginia Association of Visiting Teachers/School Social Workers
School Social Work Association Of America  
Combined Membership Application
                                                                                           Membership Year____________
______________________________________                  ______________________________________
Name                                                                                    Employer
______________________________________                  ______________________________________
Home Address                                                                    Work Address
______________________________________                  ______________________________________
City, State, Zip                                                                     City, State Zip
______________________________________                  ______________________________________
Preferred e-mail address *__________________________________________________                                           
Current Job Position (please check)                                                         Work Setting (Please check)
____ School Social Worker                                                                          Elementary                 _____
____ Visiting Teacher                                                                                  Middle / Jr. High          _____             
____ Other Title (Please specify) _________________                              High School                _____
____ Administrator / Supervisor / Director / Coordinator                          K – 12 (all schools)      _____
                                                                                                                      Central Office             _____
                                                                                                                      Other                           ____________
Regional, State and National Membership Fees                       
$25  Full VAVT/SSW Membership              $ _____
$25  Associate VAVT/SSW Membership     $ _____
$15  Student/Retired Membership                $_____          
$95   *Full/Active SSWAA Membership      $ _____
Total Combined Membership Fees            $______
Years of Service as a Visiting Teacher/School Social Worker:                                                                                                                                                             
Are You Interested In Serving/Working On Association Committees/Projects?
            Regional:           YES               NO             
            State:                  YES               NO
            National:            YES                NO
 Mail Membership application to:                  
                                                                        P.O. BOX   120593                                                      
                                                                        Newport News, VA 23606
*SSWAA Membership is effective for 1 year from the date of SSWAA's receipt of membership dues. 





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