SCMA Verification Application

School Name*
Street Address*
Address Line 2
City*
State / Province / Region*
Postal / Zip Code*
Country*
School Email*
Phone Number*
Please enter a valid phone number.
Type of School*

PrivatePublicCharter
Head of School Name*

First NameLast Name
Number of Infant Classrooms
Number of Toddler Classrooms
Number of Early Childhood Classrooms
Number of Elementary I Classrooms
Number of Elementary II Classrooms
Number of Secondary Classrooms
Program levels you would ultimately like to have participate in the program. (Note: SCMA will initially be only verifying Early Childhood levels in its first year.)

InfantToddlerEarly ChildhoodElementary IElementary IISecondary
Completed By:*

First NameLast Name
Best email for all verification correspondence*
example@example.com
Date*

MonthDayYear
Date
Application Fee

One to Five Classrooms: $200, Each Additional Classroom: $25

Fee Schedule

Verification Application FeeCovers Verification of up to Five Classrooms

$200.00 Quantity

Additional Classroom FeeAdditional Classroom Verification Fee

$25.00 Quantity

Total

$0.00