NOVA SCOTIA ASSOCIATION OF
SOCIAL WORKERS
1891 Brunswick St., Suite 106, Halifax, NS B3J 2G8 Tel: (902) 429-7799 - Fax: (902) 429-7650 P. P. www.nsasw.org

2008 RENEWAL INFORMATION
 
 
 
   
    
 

This form must be Submitted  by February 28, 2008



SURNAME: GIVEN NAME

MIDDLE:

CURRENT HOME ADDRESS:

 POSTAL CODE:

PHONE:

DATE OF BIRTH: D M Y 

FEMALE   MALE  
FAX NUMBER:

HOME E-MAILADDRESS:

CURRENT EMPLOYER: 

ADDRESS:

POSTAL CODE: PHONE:


FAX NUMBER:     POSITION TITLE:

WORK E-MAIL ADDRESS:

WOULD YOU PREFER MAIL SENT TO:         Home Mail    Office Mail


ARE YOU APPLYING TO CHANGE YOUR  REGISTRATION  STATUS AT THIS TIME?  
Yes       No           

IF YES,  EXPLAIN :                                             

 
NOTE:  If you will be practicing Social Work anytime from January 1 - December 31, 2008,
you must be registered and pay the prescribed fee.  

By-law changes at a Special Meeting of the membership on November 6, 2006,
eliminated non-practising status.Inactive status is available to Registered Social
Workers & Social Worker Candidates who are unemployed or
on maternity or parental leave or on long term disability.

ARE YOU ABLE TO PROVIDE SOCIAL WORK SERVICES IN A LANGUAGE OTHER
THEN ENGLISH?   YES NO


If yes, which language?

Do we have your permission to share this information with organizations or  individuals
seeking Social Work services in this language?YES NO

PAYMENT OF MEMBERSHIP FEESAmount  $
Method of Payment
 
Cash Cheque Money Order Visa Master Card American Express
Card Number Expiry Date (mo/yr)
 

Should you require Financial Assistance with paying your fees, please contact the Executive Assistant, 
Marilyn Marcon  at  429-7799  by
March 31 , 2008. The Financial Assistance Program operates like an interest free loan.
NSASW pays the successful applicant’s complete
 registration fee by the deadline, allowing the member to practice social work.
The member repays the Association with a series of  post dated cheques or authorized credit card
payments set up according to a re-payment schedule.                                                                    
 

FIELD OF SOCIAL WORK PRACTICE:   MAJOR   PRACTICE)

 

GROUP A - ( Select  one  only)
 
Direct Counselling/Therapy  Social Policy Development

Management/Administration/Supervision Community Development
 

GROUP B - (Check all that apply)
 

Addictions                                          Long -Term Care Services
Adult Protection
Mediation
Child Welfare/Child Protection 
Medical Social Work
Community Practice (Advocacy,Support Services, Referral)
  Mental Health Social Work
Community College Teaching
Consultation (Any Field)
School Social Work
Corrections/Parole/Justice
Employment and Income Assistance
Employee Assistance
Social Work Education/Research
Individual/Couple/Family/Group therapy
Transition House Services
Home Care
Veterans Affairs 
Hospital Social Work                        Other(Name)

 

PROFESSIONAL DEVELOPMENT: You were required to complete 40 hours of professional
development  between January 1st - December 31st, 2007 according to the NSASW Standards
of Practice.

 
Please ensure that the enclosed Professional Development Report Form is returned with
your renewal form.   
Your renewal will not be processed without this form.
 

VOLUNTEER FOR NSASW: (Check if you would like to be contacted)

Appointment to Board of Examiners (positions become available periodically
when the term of a current members  expires) 
Work on Committee or working group (please specify)   
Serve on an Editorial Committee for Connection

Be a Resource Person to NSASW (eg. Technical support, expertise in a particular subject area.)
Other

Standing Committees, Ad Hoc Committees, and Working Groups include
 
 Social Justice/Social Action; Program; Professional Development; Public Relations; Membership;
Standards and Ethics; Nomination; Private Practice; Health Interest Group; Child Welfare
Interest Group; Legislation; Candidacy; SW Practice.
 
ELECTRONIC COMMUNICATION:
NSASW has a listserv which enables the Association office or any person registered on the
listserv to send and receive messages to/from all on the list.  It provides a quick and easy way
to disseminate information or to exchange ideas. Do you want to subscribe to the listserv?
Yes  No         Already on Listserv
 
E-mail Address:
 

You can give my contact information to my Regional Representative to be used to let me know
about regional events. Yes No

 
Name: Date:    (DD/MM/YY)
 
The information on this form is collected because, for regulatory purposes, NSASW needs to know contact and employment information for Registered Social Workers, Registered Social Worker Candidates, and provisional Registered Social Workers.  The information is also used to communicate with, and provide benefits to members.  Names and addresses are provided to the CASW so that national information can be sent directly to NSASW Members.