FCCAM Professional Membership Application

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FCCAM welcomes all of Maine’s legally operating Family Child Care Providers and their staff to join us in our goal of the achieving the highest standards in Maine’s diverse legal family child care homes promoting the physical, intellectual, emotional, and social development of the children in our care.

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Today's Date *

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Provider Name (First, Last) *

E-mail Address *

Childcare Business Name *

Childcare Physical Address (Street, Town, Zip) *

Childcare Mailing Address (Street, Town, Zip) *

County *

Phone Number (xxx) xxx-xxxx *

License Capacity *

Would you be interested in serving on any of FCCAM's committees? *

Professional Learning

Outreach

Public Policy

Governance

I'm not sure what those committees do, so I would like more information please.

Not at this time, thank you.

Υποχρεωτική

Please consider joining National Association for Family Child Care (NAFCC, https://www.nafcc.org). Members receive discounts to NAFCC online training, accreditation, and the annual family child care conference. Membership fees also help to support our "voice" at the federal policy level. FCCAM will reimburse you $35 of the total cost of membership for the first year, while funds last. *

Yes, I would like to become (or I already am) a member of NAFCC for $45. I will submit my proof of payment for reimbursement once it is completed.

I'm not sure. I would like more information on what that entails.

No thank you, not at this time.

Are you interested in becoming Nationally Accredited? *

Yes, I am - or - I am already in the process.

I'm not sure. I would like more information on what that entails.

No thank you, not at this time.

Staff Members: Please list the childcare that you work for

Annual Membership Fee *

(Class A) Family Childcare: Licensee - $25

(Class A) Family Childcare: Staff - $15 (employing licensee must be a member)

(Class A) Licensed Exempt Provider - $25

(Class B) Early Childhood Education Student - $15

Payment Method *

Please send me a PayPal Invoice

I will mail a check to FCCAM, Attn: Courtney Arrants, 100 Station Road, Bradford, ME 04410

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