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PSC MEMBERSHIP UPDATE FORM 

 

Please print the form.  Complete it and send to:

Professional Staff Congress
61 Broadway, 15th Floor
New York, NY 10006
   ATT:  Diana Rosato/ Membership Coordinator

NAME

First Name __________________________________________________________________________________________________

Middle Name _________________________________________________________________________________________________

Last name _________________________________________________________________________________________________

HOME ADDRESS

Number and street _________________________________________________________________________________________________

Town/city _________________________________________________________________________________________________

State and ZIP _________________________________________________________________________________________________

PHONE

Home Phone _________________________________________________________________________________________________

Office Phone _________________________________________________________________________________________________

COLLEGE  (Retirees* -- See note below.)

Teaching College _________________________________________________________________________________________________

Payroll College**    _________________________________________________________________________________________________              

Rank _________________________________________________________________________________________________

Department _________________________________________________________________________________________________

EMAIL

Email address _________________________________________________________________________________________________

 

*If you are a member of the PSC retirees chapter, please indicate "retired" followed by the college where you were employed (e.g. "retired/Hunter") in the "college"
field. Then skip the "payroll college," "rank," and "department" fields and complete the form by going to "email."

**For example, if you are paid by the Graduate School but teach somewhere else at CUNY, the Graduate School would be your payroll college.