SEG Academic Partner Application

Institution Name*

Mailing Address*

Street Address

Street Address Line 2

CityState

ZIP Code

Physical Address (If different from your mailing address.)

Street Address

Street Address Line 2

CityState

ZIP Code

Main Phone*

Please enter a valid phone number.

Website*

Number of Employees*

Academic Partners must have at least three employees or students. If more than 3,000, please contact us for additional instructions.

Number of Students*

Academic Partners must have at least three employees or students. If more than 3,000, please contact us for additional instructions.

Nearest Ascend Financial Center*

Distance From Your Business*

Must be within a 25-mile radius of an Ascend Financial Center.

Is your business in the field of membership of another credit union?*

YesNo

Which credit union?

President/Director of School(s)*

First NameLast Name

Human Resources Manager

First NameLast Name

Benefits Coordinator

First NameLast Name

Authorized Representative*

First NameLast Name

Representative Position/Title*

Representative Direct Number*

Please enter a valid phone number.

Representative Email*

Signature of Authorized Representative*

By submitting this application, you are requesting access for your employees, students, and members to join Ascend Federal Credit Union. By clicking submit, you also agree to our Privacy Policy and expressly consent to receive communication from us at the email address provided above or that you may provide in the future.

Please verify that you are human*