School Age Application (33 or Less Capacity/MD EXCELS Member) Registration for School Age Programs with 33 or less licensed capacity. Member of MD EXCELS. 2020 Annual School Age Membership Application & Profile- All Staff are MSCCA Members If you operate more than one licensed school age program, please reproduce this form, complete a membership application and profile for each program. Please include all programs under common ownership. A copy of your child care license must be submitted with your application. MSCCA is a 501(c)(3) Charitable Organization, EIN:52-1398476 If you are a renewal and require an invoice, please contact email@example.com. Why become a member? TOTAL NUMBER OF ALL CENTERS IN YOUR PROGRAMPlease enter a number from 1 to 100.MEMBERSHIP STATUS*New MemberRenewalEMPLOYEES*Please enter a number from 1 to 2000.Total number of employees in this program.MD LICENSE NUMBER*Please enter your Maryland State License Number for your program.PROGRAM FUNCTIONS ASFor ProfitNot For ProfitACCEPTS SCHOLARSHIPS Yes No Formerly known as Subsidy Vouchers.ACCEPT SCHOLARSHIPS (Formerly known as Subsidy Vouchers)*YesNoOCC License Capacity*PROGRAM CONTACT NAME First Last TITLENAME OF PROGRAM:*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 Phone*COUNTY*Email PROGRAM WEBSITE OWNER'S NAME First Last OWNER'S EMAIL Enter Email Confirm Email MEMBERSHIP DUES FOR CALENDAR YEAR 2020MSCCA Program Membership and benefits includes all staff employed in your program as members. Copy your program membership certificate for ALL staff and use for Professional Activity Units, discounts for training and more.Membership Dues Price: $19.85 Minimum Center Capacity Dues = $52.50. MD EXCELS members receive a 10% discount = $47.25 After July rate is prorated each month.Donation to Government Relations - Advocacy for Members Fund MSCCA is respectfully requesting an additional donation of $25.00 for programs of 50 or less children; or an additional donation of $42.50 for programs with 51 or more children, to fund the Professional Government Relations Lobbyists for the 2020 Legislative Session (Annual Fee for Compass Government Relations is $38,450.00). Optional: MSCCA Passion for Excellence Grant/Scholarship Tax Deductible donation. MSCCA Members only are eligible to receive grant. All donations go directly back to our MSCCA programs/providers. Choose your donation amount.Total Amount Due $0.00 Follow us on Facebook!