Membership Application

Member Applicant's Organization
School Name*
Program name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone number*
Website*
Department*
Degrees Offered
Levels of degrees offered within the program (Certificate, Associate, Baccalaureate , Masters, Doctorate )*
Department Contact
Council business communication, publications and other correspondence will be addressed and sent to this person.
Name*
First Last
Title*
- Same address as above
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Billing Contact
Name
First Last
Title
- Same address as above
Address
Street Address City State ZIP Code
Phone
Additional Sites
You must include an additional $50 for each additional site. If sites do not use the same curriculum, each site must apply separately for accreditation.
More sites?
- Yes
- No
Sites*
Site name City State
Create User Log-in
Email*
Password*
Enter Password Confirm Password
Payment
Fee
Total
Payment Method
- Credit Card
- Check
Credit Card*

Discover
MasterCard
Visa
Supported Credit Cards: Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
CAPTCHA

Site name	City	State

Member Applicant's Organization