Application Form

Please fill out the website Application Form below, and attach all required documents.

(If you prefer to submit a hard copy, then you may download and print the APPLICATION and mail to National Independent Private Schools Association,
1856 N. Nob Hill Road- Suite #619, Plantation, Florida 33322
If you do not receive a reply from us within 48hrs, then please mail the application or call us.

Web Submission

Date *

Name of Organization *

Name of Program if different from above

Name of Director *

Address *

City *

State *

Postal Code

Phone *

Fax

Email *

Website

We are applying for *

Academic Accreditation

Therapeutic Certification

Both

School Therapeutic Programs

Young Adult Transitional Programs

If the program/school is academically accredited by one of the following accrediting association or agencies please indicate *

An agency or association that is a member of the NCPSA

For therapeutic schools and programs - CARF, COA or The Joint Commission (Formerly JAHCO)

The Middle States Association of Commission on Elementary and Secondary Schools

Other

...If above answer "other", then please provide name

If the school is accredited by an association or agency approved by NIPSA are you applying for dual or reciprocal accreditation? *

yes

....If yes, please give the date of the school’s initial accreditation

...and the expiration date.

If your school is not accredited or certified at this time, but you are seeking accreditation or certification with another agency, please indicate in what year you anticipate accreditation or certification and the name of the agency *

The school/organization has legal authority to operate in its state.
(All documents relating to local, state and federal regulations governing the operation of the school/program must be attached - such as Business License Cert of Occ., Cert of Use, Inspections, etc.) *

yes

The owner or representative is the chief administrative officer of the school/organization and is properly prepared to direct and manage the school/organization. *

yes

...Qualifications (Attach qualifications.)

The school/organization has been in operation for two (2) years with enrolled students or clients. *

yes

The school/organization has a written statement of its mission and goals, and a statement of non-discrimination. *

yes

Enter mission and goals, and statement of non-discrimination below (Attach documentation.)

The school/organization can demonstrate its ability to provide appropriate resources for fulfilling its purposes. *

yes

The professional expertise of each staff member is demonstrated through one or more of the following criteria:
a. Holds appropriate qualifying certificates.
b. Has a baccalaureate or higher degree from an accredited or recognized college.
c. If not meeting one or both of the above, must have a letter in his or her permanent record with documentation why he or she is especially or uniquely qualified in the assignment.
d. The therapeutic staff is fully qualified for the roles they have been assigned. *

yes

The school or organization has adequate materials and facilities to fulfill its mission. *

yes

The owner or designated representative has expressed in writing his or her organization’s (or school’s) intent to be accredited and/or certified by NIPSA. *

yes

The school or organization, by completing this Candidacy Form, is willing to comply with all accreditation fees and expenses; provide necessary information to NIPSA and official representatives as they fulfill the accreditation process; and shall allow its accreditation status to be published or otherwise known to other agencies, institutions or individuals. *

yes

The applicant acknowledges that membership or accreditation can be cancelled if in the opinion of the NIPSA board of directors the school or organization has violated a law or has not met the standards of ethical conduct as established in the NIPSA Code of Conduct *

yes

NOTE: If you marked “no" for any item on any of the above 10 items, please call the NIPSA National Office at 305-630-2557 for clarification, or provide an explanation below.

Please describe your program. If you have an academic component, please mark (x) in the appropriate boxes below for grade levels offered at your school: *

Preschool

4 year old Kindergarten

5 year old Kindergarten

Elementary through Grade 6

Elementary through Grade 8

Middle School / Jr. High 6-8

Secondary 9-12

other

...other, please describe below

Total School/Program Enrollment

Date School/Program Established

If you are applying for therapeutic certification please indicate the level for which you are applying

If your school is an Emotional Support and Development Program growth or a young adult transitional program please describe the activities or educational component of your school

Is the school or organization established as a for profit entity (Answer must be yes)? *

yes

Describe the school or program’s organization (For-Profit Corporation, For-Profit LLC, sole proprietorship, etc.): *

Do you use a specific curriculum or system in your academic or therapeutic program? (ie. Montessori, etc.) *

yes

N/A

... if above "yes", then please specify

Do you anticipate a curriculum change or a change in therapeutic approach or program change in the future? *

yes

N/A

... If above "yes", please describe the changes you will be making:

Is your school approved, accredited or certified by the state? *

yes

Please provide two professional references, if a therapeutic certification one additional must be clinical
(name, address, phone)

Attach required documents. Please include copies of your brochures and other information provided to prospective patrons. (pdf, jpeg, doc, or docx files only)

Maximum file size: 516MB

By submitting this form, I certify that I have read the membership and fee requirements of the National Independent Private Schools Association (NIPSA) and I agree to maintain my membership and/or candidacy in good standing. I certify that this school or program is a privately owned, for-profit, tax-paying entity. I also acknowledge that I must apply for accreditation and certification, conduct a self-study and undergo a site visitation by a team of my peers within three (3) years of becoming accepted for candidacy. This Application for Candidacy submitted to the National Independent Private Schools Association is a true representation of our proprietary school or organization. I have read all of the eligibility requirements and the fee schedule. I understand that this letter and application are only the beginning of the process. Application fee of $500.00 must be submitted following this application.

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Phone Number

Application Form

Please fill out the website Application Form below, and attach all required documents.

Web Submission

Quick Links

Benefits

Contact

305.630.2557

office@nipsa.org