School Age Application (34 or More Capacity) Registration for School Age Programs with 34 or more licensed capacity. Not a Member of MD Excels. 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 PROGRAMS IN YOUR ORGANIZATIONPlease 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.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 2019MSCCA 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. Calculate formula = Licensed capacity (OCC license) x $1.90 Membership Dues Price: $1.90 MSCCA has a MAXIMUM dues cap not to exceed $1250.00 should the same owner have more than 15 programs.OCC Licensed Capacity of This Program*Optional: Contribute to Government Relations Advocacy Choose your donation amount.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.Optional: National Child Care Association Annual Dues = $22.00 Total Amount Due $0.00 Follow us on Facebook!