MSCPA Student Membership Application


Take advantage of all the benefits and opportunities afforded by being a Student Member of the MSCPA.

Please fill out form completely:

E-Mail Address:     

FULL NAME
First:              
Middle:             
Last:               

Name (As you would like it to appear on your Membership Certificate):
                    

Home Address:       
City:               
State:              
Zip/Postal Code:    
Area Code/Phone:


PERSONAL INFORMATION

Friends call me:    
Date of Birth:      
Place of Birth:

 

EMPLOYMENT INFORMATION

Please provide name, city and state of employers and dates of employment.

Employer:   
City:       
State:      
Position:   
Dates from: 
to:         

Employer:   
City:       
State:       
Position:   
Dates from: 
to:         

Employer:   
City:       
State:      
Position:   
Dates from: 
to:

MEMBERSHIP INFORMATION

Membership in Accounting, other professional or civic organizations
(please indicate if past or present status)

Name of Organization: 
Office Held:          
Membership Status: Past  Present

Name of Organization: Office Held: Membership Status: Past Present Name of Organization: Office Held: Membership Status:

EDUCATION

High School:       
Degree obtained:   

College/University:  
Degrees obtained:  
Date:



APPLICANT STATEMENT

I, the undersigned, apply for admission to the Mississippi Society of Certified Public Accountants as a Student Member, and I agree to abide by the decision of the Board of Governors as to the disposition of this application.

 

Signature:___________________________________  Date:_____________
                         (if printed or faxed)


ENDORSEMENT OF SOCIETY MEMBER

Sponsor's statement: I have been personally acquainted with the applicant for:
(months/years, etc.). 

Full Name of Sponsor:

Signature:___________________________________  Date:_____________
                         (if printed or faxed)

If you have ever been suspended or expelled from any professional organization, please explain conditions under which it terminated:



How to Apply:

         Questions? Call the Mississippi Society of Certified Public Accountants at (601)856-4244. or email us.


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