Psyvo Membership Application Psyvo membership is for counselors prepared to lead, provide compassionate care, and shape the future of mental healthcare. If you have met these qualifications, submit your application. First Name Last Name School Name School Email Address Birthday Phone Number Preferred method of contact Phone Text Message Email Gender Male Female Other Prefer not to respond Race/Ethnicity American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Two or more races Prefer not to respond Current Classification Student (Graduate) Alumni Other Professional Counseling Professional License Track Licensed Professional Counselor (LPC) Licensed Mental Health Counselor (LMHC) Licensed Professional Clinical Counselor (LPCC) Licensed Marriage and Family Therapist (LMFT) School Counselor Substance Abuse Counselor Rehabilitation Counselor Expected or Actual Graduation Date What is your current overall GPA Total semester hours completed Are you classified as an international student by your school? Yes No Mailing Address Address Line 2 City State Zip Code Consent & Certification I have read and accepted the Psyvo Inc. Membership Terms. I consent to receive communications from Psyvo Inc. regarding products, services, and promotions. Your email will not be shared with third parties. I certify that all information is true and accurate. I authorize Psyvo Inc. to review my records for the sole purpose of determining my membership eligibility. Enter Your Full Name to Certify Submit Application