KAIMH Membership Application

2008 KAIMH Membership Application

(Kansas Association for Infant and Early Childhood Mental Health)

KAIMH's membership year follows the calendar year. During this period of reorganization, we have not collected dues to give us time to review other states' materials. Now we are ready to build a formal membership list that will require dues. We ask that you send in your membership form with payment to enable us to continue the exciting work that we are undertaking. In May, we will present a slate of officers for election by the membership. Early Childhood Mental Health Endorsement is now a primary endeavor for KAIMH as we pursue our goals of having fully trained competent professionals in every area that affects infants, toddlers, and young children. We will continue to build benefits for KAIMH members that may include regional chapters, more opportunities for training, and steps to professional endorsement. This will be a process. Show your support by joining today.

Facts about Early Childhood Mental Health Endorsement in Kansas

Leadership and task force groups are working on all aspects of bringing the Michigan Infant Mental Health Endorsement system into Kansas
The endorsement system will impact professionals working in mental health, education and child care, social services, assessment and special education, health clinics and hospitals, the judicial system, home visitation programs, universities and training programs, early childhood research, advocacy and policy
A small self-selected group of Kansas professionals will become mentors, and portfolio and test reviewers. Preparation for these tasks includes submission of professional portfolios, demonstration of professional competence based on results of a 3 hour exam, and participation in training with members of the Michigan Endorsement staff.
A system to assist Kansas professionals with training, applications, and achieving endorsement will be a process that will need several years to develop
The KAIMH website and email distribution list will be just one of the ways that you can stay informed about this exciting endeavor

New Member_______ Renewing membership______

(Please print or type)
NAME________________________________________________________DATE______________________

TITLE____________________________

PROFESSION__________________________________________ DEGREE______________________

HOME ADDRESS _____________________________________________________________________

_____________________________________________________________________________________

WORK ADDRESS _____________________________________________________________________

_____________________________________________________________________________________

Preferred Mailing Address: Home_______ Work________

TELEPHONE: Work:_________________ Home:____________________ Mobile: ________________

FAX: ________________________________

Email:__________________________________

Are you a member of WAIMH? _______YES _________NO

DUES Regular Membership: $35_____ Student: $15_____ (Include copy of ID)

Please answer YES or NO: I will allow my contact information to be posted in a member’s only area of the association’s website. _______YES _________NO

Federal Tax ID#: 48-1174660

PLEASE PRINT, COMPLETE, AND RETURN TO: KAIMH, PO Box 3903, Topeka, KS 66604-3903