ACSI Membership Application

  • To review the Memberships Benefits visit our website Membership Benefits
  • Click on the icon next to a field for more information. Be aware that popup blocking software may disable this functionality.
  • Fields outlined in blue are automatically calculated. use the recalculate button at the bottom of this page to update these fields anytime.
  • Note: For EE-12 programs or any combination such as EE-6, EE-8 must join the entire program as per prescribed policy.
  • If your school is a part of a system of schools, please complete an application for each campus. System office will only be billed. Affiliate campuses are for information only.
  • If you have any questions about this online application, please email webmaster@acsi.org or call (719) 528-6906 and ask for Membership Department.
  • Receipt of this form indicates permission for ACSI to contact you via the school email address or fax number, and acknowledges, that your school's contact information may appear in the annual Membership Directory

Application
Application Type
Customer Number Prefill Form

Contact Information
System Office

name
postal code
schools
Early Ed Program Name
Mailing Address

city
state/province
postal code
Physical Address

city
state/province
postal code
Country
Phone
Fax
Year Founded
i.e. 1975
Email Confirm email address
Website
Sponsoring Organization

type
name
Denomination

Leadership
Administrator

name
title
email		 Confirm Administrator's email address
Early Ed Director 1

name
title
email		 Confirm Early Education Director 1 email address
Early Ed Director 2

name
title
email		 Confirm Early Education Director 2 email address

Total Teacher Count  

Student Enrollment
Early Ed Fee Details

Early Ed 0-1 Yr (FTE)
Early Ed 1-2 Yr (FTE)
Early Ed 3-4 Yr (FTE)
Early Ed 5 Yrs (FTE)
Kindergarten
Before and After School
Enrollment Total

Enrollment by Ethnicity

Enter as percentage of total student enrollment
African %
Asian %
Hispanic %
Native %
African American %
Caucasian (White) %
Native American %
Other %

Programs
Urban School   (socially/academically at-risk)
In Development
Accredited By

Individual Memberships (optional)

For IACEE, IACSA, and IACSB, enter the number of members in the first field and then list the full names and email addresses of those members in the second field.
IACEE
International Association of Christian Early Educators		 $30 each
# of Individuals
IACSA&B
International Association of Christian School Administrators and Board Members		 $75 each
# of Individuals

Legal Defense
Reimbursement Program (optional)
Legal Defense Fee
$199 		Yes, I want the protection of the Legal Defense Reimbursement Program
I have read the indemnity agreement (Form - IA/2009)
 Yes
Number of School Employees (Part Time & Full Time)
1. Has the school had an employment related claim for damages or employment related lawsuit (including any arbitration, state civil rights proceeding, administrative proceeding or EEOC investigation or lawsuit) within the last three years? If so, briefly explain each.
2. Has the school had a student related claim for damages or student related lawsuit within the last three years? If so, briefly explain.
3. Is the school aware of any past or present situation that could result in any claim being made against the school by any past or present school employee or student? If so, briefly explain.
4. Does the school have a written contract for any employees? If so, please indicate which employees.
5. Does the School have a mandatory Christian conciliation/arbitration clause in employment contract?
6. Does the School have an employee handbook?

Detailed Profile (optional)
Include Detailed Profile
$55

Fees

Note: To System Offices you will only be charged for the System Office total. The total for each affiliate campus in your system if for information purposes only. To ensure you are viewing corrected fees, please click the RECALCULATE button at the end of this form.
School Fee
Student Fee
Individual Memberships
ACSI Legal Defense Reimbursement Program
Detailed Profile
Legal Donation
Early Education Missions Fund Gift
Billing Fee
Total Fee

Payment
ABOUT SSL CERTIFICATES
Payment Method
$26.00 billing fee will apply when your school is billed.
Please note Billing option is not available after January 31, 2010
Credit Card Type
Credit Card Number Please do not include hyphens or special characters while entering your credit card number
CSC Number
Name on Card
Expiration Date
Deferred Billing Yes, I am paying by credit card and wish to defer half of my membership fees (school fee + student fee + $26.00 billing fee) until February 1.
Total Amount

Note: To ensure you are viewing corrected fees, please click the RECALCULATE button at the end of this form. Also, If you switched your payment method make sure you hit RECALCULATE.
Note: To System Offices you will only be charged for the System Office total. The total for each affiliate campus in your system if for information purposes only.

Signature
Applicant

name

email (Confirmation Receipt Of Membership Application will be sent to this email address)
notes
Code of Conduct &
Statement of Faith 		Click here to view ACSI's code of conduct.
Click here  to view ACSI's Statement of faith. By checking the box below, you affirm that you agree with ACSI's statement of faith, that your school's full and part-time personnel and board members are followers of Christ, who acknowledge Jesus as Lord and Savior and that your school does not discriminate in employment on the basis of gender, race, national or ethnic origins, age or disability, nor does the school discriminate in enrollment or in the provisions of its programs or services on the basis of gender, race, national or ethnic origins, and the receipt of this form indicates permission for acsi to contact you via the school email address or fax number, and acknowledges that your school's contact information will appear in the annual membership directory.

Signature Date
Remember to print a copy of this application for your records before submitting.
Your copy of this application is your itemized invoice and receipt
(Reset Form) Recalculate Submit Application