NASS Membership Application

Please fill out the following information. If the school is in the planning stage, please enter working name, grades desired, etc.

Name of School (If Applicable):
Name of 501-c-3 Tax Umbrella (If Different):
Contact Person/title:
Address:
Phone: ()
Fax: ( )
Website:
Email:
Grades Served:
Number of Students:
Number of Employees:
Year Founded:
Ethnic Breakdown (or Potential Target Group) In %:
% Anglo
% African American
% Hispanic
% Native American
% Asian
% Other (mixed race)


Please answer the following questions to the best of your ability. It is not expected that schools will initially have all the answers. If questions arise, do not hesitate to contact NASS is a large part of its services will be to assist you in working through these issues.

1. Describe the Lord’s call on your life to start or work at a school for at-risk kids.




2. Describe the need for such a school in your city or area. Please use actual statistics.




3. What is your target group? High school Junior high Elementary Pre-school




4. What is your mission statement or purpose?




5. If you answered no, can you agree wholeheartedly with the NASS Statement of Faith located on page 11
of the NASS Membership Guide? Yes No




6. Do you have a board of directors? Yes No How many members?
Their professions?
How much support do they provide the school – financially, work, etc?(*Please attach a board list.)




7. Are you incorporated? Yes No In what state?
Date of incorporation:




8. Do you have a 501-C-3 license? Yes No
*Please attach a copy of your letter from the IRS.




9. How is your school financed? What is your development plan? Is your income tuition or donor based?
Do you have a sliding scale for tuition?




10. Do you have a budget? Please include a budget that shows both income and expenses for the upcoming school year.

11. Describe your accounting process. How is your income (tuition and donations) managed?





12. Describe your organizational structure. Administration, faculty, classified personnel.





13. What is your current physical plant? church? school building? office building? What is your relationship with the owners?





14. What courses need to be taught according to state mandates in order for you to award diplomas?
What credits are needed to graduate?





15. What curriculum are you using/do you plan to use?





16. If your school is already in operation, please give its history.





17. Strategic plan – What are your goals and objectives for your first six months? 1 year? 3 years? 5 years?
Please give projected number of students, number of staff, expected budget, etc.




Checklist

• My $149 NASS application fee is enclosed and I understand that to continue my NASS membership and have access to the NASS web site, my renewal fee is due by July 15 of each year.
  
• A list of our Board of Directors and their affiliations is attached
  
• A copy of our 501 C 3 letter from the IRS is attached.
  

Name of person completing the application (please print)




SignatureDate