NAPSEC Membership Application

Executive Director

 /Program Head

 Organization
Street Address
City/State/Zip
Phone
Email
Fax

NAPSEC Contact

at Program

Contact's Email Address

Program Web Address

Ownership of Applicant

Corporation, non-profit

Corporation, for-profit

Single Proprietorship

Partnership

Other

Name & Address of Owner, Partner or Corporation

List national/state agencies that approve/license program with dates of validation.
List national/state accreditations

 

How did you hear about NAPSEC?

 

 

Membership AZ/CA

Association Members

 

 

 

  AAPSEP

 

CA Alliance

 

Certification of Application

 

The undersigned hereby: Apply for membership.

Grant permission to public licensing agencies or any other relevant examining or reviewing agency or group to release official records and information concerning the named applicant to NAPSEC for its use, specifically with regard to consideration of this Membership Application.

 

Affirm that that agency is in compliance with all applicable local, state and federal laws and regulations required for private special education programs.

 

Agree that the named applicant, in order to maintain membership in NAPSEC, does publicly adhere to and practice the Code of Ethics of the Association. This document requires your signature. The document will be mailed with your membership materials once payment is received.

 

Name

 

Date  

 

Please check here to affirm application information

provided is true and correct.

 

Membership

Dues

Levels

Please check appropriate dues payment box

 

Dues levels are based on your program's budget.

All first year members pay half price dues.

 

 Programs that have been members (non-renewals) within a three year time frame are not eligible for half price dues.

 

$600/$300.00             $0 - 750,000

$1,177/$588.50          $750,001 - $1,250,000

$1,622/$811.00          $1,250,001 - $3,000,000  

$2,089/$1044.50        $3,000,001 - $4,800,000

$2,546/$1,273.00       $4,800,001 and above

 

Voluntary dues are for members who wish to make an additional contribution to the association.

 

Sustaining/$2,600   Contributing/$2,955

Friend/3,385         Gold/$4,430  Platinum/$6,150

 

 

Pay By Check

 

Please check here if paying by check

 

Mail Payment To:

NAPSEC, 601 Pennsylvania Avenue, NW,

Suite 900 - South Building

Washington, DC 20004

 

Credit Card Payment  Visa       MasterCard      American Express
Credit Card Number
Expiration Date
Name on Card

Total Paid by

Credit Card

THANK YOU!

WELCOME!

Watch for your membership materials in the mail!

Please make

a copy

for your files.

 

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