Associate Membership Application

Please complete the fields located below. For additional information, please contact [email protected].

Associate Membership Application

General Institutional Information

Institution(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Website(Required)

Degrees Awarded(Required)

Other

Other Degrees

Approximate percentage of total credits required for graduation that are classified as general education(Required)

Please enter a number from 0 to 100.

Approximate percentage of total number of degrees awarded annually classified as associate(Required)

Please enter a number from 0 to 100.

Accreditation Status(Required)

Accredited

Candidate for Accreditation

Not Applicable

If you selected “Not Applicable,” please explain status.

Year Accreditation Attained (if applicable)

U.S. Regional Accrediting Association

President

Full Name(Required)

Title(Required)

Email(Required)

Phone(Required)

Chief Academic Officer

Full Name(Required)

Title(Required)

Email(Required)

Phone(Required)

Person Completing This Form

Full Name(Required)

Title(Required)

Email(Required)

Phone(Required)

Which CIC programs and services are of particular interest to your institution?

Additional Information

Link to Annual Report

Comments

This field is for validation purposes and should be left unchanged.

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Associate Membership Application

Associate Membership Application