National Independent Study Accreditation Council

(Print out the following form, fill in, and mail to NISAC

with accompanying documents - see "Application Process" page.)



Application for: ___ Candidacy  ___ Accreditation ___ Renewal


Name of School :__________________________________________________Date:__________  

___Administrator ___ Principal:_____________________________________________________

School Phone: ________________________ Admin Home Phone: _______________________

Admin Cell:___________________________School Fax: ________________________________

School Address:__________________________________________________________



Mailing Address (if different):_______________________________________________________


Year Established:___________ For Profit:____________ Non-profit:__________

Geography of enrollment: ___ Local ___ State ___ National ___ International 


Current # of Students:______________Grades Served:___________________


Number of Staff: ____ Full Time  ___ Part Time  ___ Volunteer    



                                                           Accreditation Information


List Other Accreditations, if any (Include proof of current membership):






Have you ever been denied, terminated, or resigned from accreditation:


___Yes ___No            If yes, please provide details:                                                                                                                            


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