Member Application Form for Accreditation by NAC, the National Accreditation Council for Blind and Low Vision Services. New York (NYC), Los Angeles (L.A.), Chicago, Washington D.C., San Francisco, Philadelphia, Dallas (DFW), Boston, Detroit, Miami, Houston, Atlanta, Seattle, Phoenix, Minneapolis, Cleveland, San Diego, St. Louis, Denver, Tampa, Pittsburgh, Cincinnati, Charlotte, Portland, Kansas City, Indianapolis, Orlando, Columbus, San Antonio, Milwaukee, Las Vegas, Virginia Beach, Norfolk, Providence, Salt Lake City, Greensboro, Nashville, Raleigh-Durham, Austin, New Orleans, Louisville, Grand Rapids, Hartford, Memphis, Buffalo, Jacksonville, Oklahoma City.

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APPLICATION FOR MEMBERSHIP

An incorporated entity or unit thereof, or governmental entity or unit thereof, is eligible to apply for accredited membership if it meets the following criteria:

* The entity or unit has been in existence for at least one year

* It serves persons who are blind or otherwise visually impaired as its primary function

* One or more of its major services to blind or visually impaired persons is encompassed by NAC standards of rehabilitation and/or education

* Its authorizing instruments are issued by legal jurisdiction

* It has a designated governing authority

* It is identified by an official and authorized discrete name

Information About the Applicant & Formula For Calculating Annual Membership Dues

In all cases, your answer is added after (to the right of) the question.

NOTE: An application fee of $400 will be charged following the acceptance of your application.

Official Name of the institution:
Mailing Address:
Phone Number(s)
Web address
Name & Title of Chief Administrator
Email Address of Chief Administrator
Name & Structure of Governing Authority
Gross Operating Expenses For Current Fiscal Year
Number of Full-Time & Part-Time Employees
Persons served (unduplicated)
Date of Application
Brief Description of Services Offered
Gross Operating Expenses ($)
1. Less Depreciation ($)
2. Less Cost of Raw Materials ($)
3. Less Capital Expenses ($)
Total Exclusions (Add 1, 2 & 3)($)
Adjusted Gross Operating Expenses x 0.001 ($) (Subtract Total Exclusions)
Annual Membership Dues ($)
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MINIMUM ANNUAL DUES IS $300; MAXIMUM IS $3,000

END OF FORM

Please contact the NAC office if you have any questions or need more information.

You may use our contact form by clicking here
or contact us using the information below:

National Accreditation Council
for Blind and Low Vision Services (NAC)
Steven K. Hegedeos Executive Director
7017 Pearl Road
Middleburg Hts., Ohio 44130
Phone: 440-545-1601
Cell: 440-724-9781

Download(.doc): Membership Application Form -doc

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