NECPA Enrollment Form

Program Name*

Street Address*

Street Address Address Line 2 City State ZIP Code

Is this also your shipping address?*

Yes
No

Shipping Address*

Street Address Address Line 2 City State ZIP Code

Director*

First Last

Program Email Address*

Phone Number*

Fax Number (If applicable)

Owner Name*

Is Your Program Center-Based or Home-Based?*

Center-Based
Home-Based

Alternate Contact Name*

Alternate Contact Phone Number*

State License Number*

Please Upload a Copy of Your State License*

License Capacity*

Number of Classrooms*

Number of Buildings*

Is your program working with a third-party consultant during the self-study phase?*

Yes
No

Consultant Name

First Last

Consultant Email

NECPA Enrollment Fee*

Select Your License Capacity Tier

Additional Products

Select All
Additional NECPA Self Assessment Instrument (One copy is included with application fee)
Additional NECPA Standards Book (One copy is included with application fee)
Additional Documentation Box Labels (One set is included with application fee)
Parent Flyers (Flyer designed to acquaint parents with the accreditation process and its value, 25 per order)

Agreements

1) I understand that the NECPA accreditation is valid for three years with the submission of an Annual Report during each of the accreditation years.
2) I understand that a NECPA Accredited program is required to maintain NECPA standards, requirements and physical plant under which the program is awarded accreditation.
3) I understand that the NECPA Commission reserves the right to revoke the accreditation of any program found to be out of compliance with the NECPA standards.
4) I understand that the re-enrollment period lasts for two years from the date of the NECPA Enrollment Letter issued by the NECPA Office and that the NECPA Verification Visit Request Form must be submitted within that time period.
5) I understand that a NECPA accredited program is asked to request a verification visit at least 8 months prior to the accreditation expiration date to prevent a lapse in accreditation.
6) I understand that a NECPA accredited program is asked to request a verification visit at least 8 months prior to the accreditation expiration date to prevent a lapse in accreditation.

Please Print Your Name To Agree To The Stipulations*

Payment Details

Total Amount

$0.00

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