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Membership Application

Please fill out the application form and send by clicking the "Submit" button. We will be in touch soon regarding additional materials we need to process your application. Those will include your most recent audited financial statement and 501(C)3 designation.


School Information:
Name of Applying School:
Type of School:
Address:
City:
State
Zip:
School Web site:
Date Founded:
Primary Contact:
Name:
Title:
Email:
Phone:
Fax:

Please respond to the following series of questions.

Answers will help to determine qualification for membership in PAISBOA.
1. What is your IRS tax determination?
2. Please provide the percentage of your revenue from listed sources (Percent of Total Revenues)
Tuition & Fees (%):
Private Gifts (%):
Endow/Invest (%):
Gov't Sources (%):
Other (%):
3. Current Student enrollment (Number)
Prior Year enrollment (Number)
4. Is your school accredited?
5. Is your school licensed?
6. From where do you draw your students?
7. Total number of employees
Number of Benefit Eligible Employees
Number of Full Time Faculty
Number of Part Time Faculty
8. Who pays your: Teachers?
Staff?
9. Is you school affiliated with any other organization?
10. Are you a separate corporation?
11. How is your governing body composed?
Is your governing body paid?
12. Who pays for your programs?
Guardians (%)
School Districts (%)
State Gov't (%)
Federal Gov't (%)
Other (%)
If you indicated Other, please describe.
13. How did you hear of PAISBOA?
14. To receive more information, indicate the individual PAISBOA programs you are interested in:
 Group Purchasing  Health Insurance  Energy  Business Insurance
Comments:
Signed (E-Signature):
Title:
Date:

RETURN A COPY OF YOUR IRS DETERMINATION LETTER, MOST RECENT AUDITED FINANCIAL STATEMENTS
AND STANDARD ADMISSION MATERIAL TO:

Aggie Malter, Executive Director
301 Iven Avenue, Wayne PA 19087
Questions? Email: amalter@paisboa.org

ANNUAL MEMBERSHIP FEES: $1.50/STUDENT (MINIMUM $350, MAXIMUM, $2,000)

Materials are for admission purposes only, and will be kept confidential and will not be returned unless requested.

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