Individual Membership Application - International Association of ESD Professionals

Applicant Information

Full Name

Phone Number

Personal Pronouns

She/ Her
He/ Him
They/ Them
Other

Date of Birth

Country of Residence

Where do you currently live?

Email Address

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

ESD Training

Describe your ESD training

Please describe who or what program trained you, the date you were certified or able to teach ESD, and where that training took place. You can also mention specific mentors or trainers here if you wish.

Other training and education

Please add any other training and educational highlights that you feel are important for us to consider.

IAESDP Credentialing Exam

Current ESD Professional Credentialed
Lapsed ESD Professional / Expired Credential
Not Credentialed

Have you taken the Association's ESD Professional credential exam?

ESD Teaching Experience

What are your current roles in the industry? (check all that apply)

Independent ESD Instructor
Mentor for ESD Instructors
Retired ESD Instructor
Board or Committee Member with IAESDP
Board or Committee Member with an ESD Organization

Years of experience teaching ESD

If applicable

Describe your mentorship experience

List the languages in which you teach ESD

Do you train, certify, and/or offer a certification program for ESD Instructors?

Yes
No

How many Instructors have you trained?

Related Experience

Do you have Martial Arts or Physical Education Teaching Experience?

Please list your relevant Martial Arts and Physical Education teaching experience.

Please list any other relevant teaching education and experience.

Supporting Documents

Curriculum Vitae or Resume

Click or drag a file to this area to upload.

Please upload your CV or resume. It may include your work experience, education, achievements, and skills. This will not be public. Files should be under 10 MB.

Certifications and Awards

Click or drag a file to this area to upload.

Upload copies of relevant certifications and awards.

Background Check

Click or drag a file to this area to upload.

If you are a US Resident, please provide a copy of a Background Check no older than 1 year from the time of your application. You can obtain your background check here: https://www.backgroundreport.com/self.

Membership Options

Please, select your Membership Tier below.

Membership Renewal Options

Manual
Automatic

Please choose whether you would like to renew your membership on a year-to-year basis (manually) or automatically. If you are experiencing a financial hardship, are receiving a scholarship, are using a discount code, or other financial assistance is required, please select the "Manual" option.

Have you been affected by the defunding of USAID and you live outside the United States?

Yes
Not Sure
No/ Not Applicable (US Resident)

We understand that instructors in countries outside of the United States have been affected by the freezing of funds to USAID Programs. If you have been directly affected, you are eligible for a scholarship for your Membership.

Briefly describe how you have been affected by the defunding of USAID.

Do you want to be considered for a full Membership Scholarship for one year, resulting in no cost to you?

Yes, I want to be considered for the scholarship.
No, I can afford to pay for my membership.

If you marked "Yes," please fill out the Financial Assistance portion of the application below. If you marked "No," you are still eligible for Tiered Membership Pricing based on Annual Income. Please select the correct Membership option from the dropdown menu.

Membership Pricing

Please select the pricing Tier that best applies to you. If you are applying for Financial Assistance through Scholarships or Sponsorships, you must complete the Financial Assistance portion of this form. We will invoice you once we receive your completed application.

Membership History

This is my first time signing up to be a member
This is a Renewal
My Membership has lapsed and I am reapplying

Promotional Code

Are you taking advantage of a special promotion? Enter your code here.

Total

$30.00

Stripe Credit Card

Financial Assistance Request

Complete ONLY if you are applying for Financial Assistance. All fields and uploads MUST be completed to process Financial Assistance Requests. If you do not require Financial Assistance, continue to the Agreements Section.

Are you a Student?

Yes
No
Part-time

Current Employer or Educational Institution

List yourself if you are currently self-employed.

Start and End Dates

Please upload any documents necessary to explain your Financial Situation, including proof of Income and Expenses

Click or drag files to this area to upload. You can upload up to 4 files.

Documentation may include paystubs, tax forms, letters from employer or instructors/ educational institutions (on organization letterhead), or a letter from you, on letterheard, certifying your income and expenses.

Agreements

I certify the following:

I agree to abide by the IAESDP's Confidentiality Policy
I agree to abide by the IAESDP Code of Ethics
I declare that the information I have provided in this applicationis true and correct to the best of my knowledge

You must check all three boxes.

Signature

Clear Signature

How did you hear about the IAESDP?

Applicant Information

ESD Training

ESD Teaching Experience

Related Experience

Supporting Documents

Membership Options

Financial Assistance Request

Agreements

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