NECPA Re-Enrollment Form The purpose of this form is to notify the NECPA Commission that you wish to re-enroll your program in the self-study process for the purpose of renewing NECPA Accreditation. Program Name*NECPA Site Number (8-Digits)*Accreditation Expiration Date* Date Format: MM slash DD slash YYYY *If you are re-enrolling less than 1 year prior to your expiration date above, please contact the NECPA Office to review your program’s timeline.Street Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this also your shipping address?*YesNoShipping Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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-BasedHome-BasedAlternate Contact Name*Alternate Contact Phone Number*State License or Registration Number*Please Upload a Copy of Your State License*Accepted file types: jpg, gif, png, xlsx, xlx, csv, pdf.License Capacity*Number of Classrooms*Number of Buildings*Is your program enrolled with Paths to QUALITY?*YesNoBy participating in accreditation, you MAY be eligible for Accreditation Financial Assistance through the Indiana Accreditation Project (IAP). You must be enrolled with Paths to QUALITY to be eligible to apply for IAP support. Learn more about Paths to Quality here https://indianaspark.com/paths-to-quality.Is your program enrolled with the Indiana Accreditation Project (IAP)?*YesNoLearn more about the IAP program here: https://inaeyc.org/indiana-accreditation-project. Is your program participating in Child Care Aware of America's Military Fee Assistance program?*YesNoLearn more about the program here: https://www.childcareaware.org/fee-assistancerespite/feeassistancerespiteproviders/feeassistance. Is your program working with a third-party consultant during the self-study phase?*YesNoConsultant Name First Last Consultant Email NECPA Re-Enrollment Fee*Application Fee for 7-60 Children ($350.00)Application Fee for 61-120 Children ($375.00)Application Fee for 120-240 Children ($450.00)Application Fee for 241+ Children ($500.00)Select Your License Capacity TierAdditional 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) NECPA Process Understandings1) 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 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.Please print your full name to agree to the above NECPA Process Understandings*Indiana Accreditation Financial Assistance UnderstandingsI understand that in order to apply for Accreditation Financial Assistance with the INAEYC Indiana Accreditation Project (IAP), I must: 1) Be enrolled and in good standing with Paths to QUALITY™ at any level, 2) Submit to IAP through their online application, an open enrollment invoice from NECPA, 3) Submit my IAP scholarship application within 30 days of my NECPA enrollment submission. I also understand that if my application for Accreditation Financial Assistance is denied for any reason, I will be responsible for the NECPA accreditation fees.Please print your full name to agree to the Indiana Accreditation Financial Assistance Understandings*Payment DetailsFees are non-refundable and subject to change without prior notice.Total Amount $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged. Δ