School Information Form
To be completed for every campus
(Please make additional copies if necessary)
Primary Contact
(This individual will receive all CCA mailings)
(Mr. Ms. Mrs. Miss) ______ First Name _______________________ Last Name ____________________________________
Title _______________________________________________________ Nickname _______________________________
Institution ____________________________________________________________________________________________
Address _____________________________________________________________________________________________
City ___________________________________________________ State _____________ Zip _______________________
Phone _________________________________________________ Fax _________________________________________
Email _________________________________________________ Website ______________________________________
Designated Delegate ___________________________________________________________________________________
(authorized person to vote for the institution)
Primary Contact
(This individual will receive all CCA mailings)
(Mr. Ms. Mrs. Miss) ______ First Name _______________________ Last Name ____________________________________
Title _______________________________________________________ Nickname _______________________________
Institution ____________________________________________________________________________________________
Address _____________________________________________________________________________________________
City ___________________________________________________ State _____________ Zip _______________________
Phone _________________________________________________ Fax _________________________________________
Email _________________________________________________ Website ______________________________________
Designated Delegate ___________________________________________________________________________________
(authorized person to vote for the institution)
Primary Contact
(This individual will receive all CCA mailings)
(Mr. Ms. Mrs. Miss) ______ First Name _______________________ Last Name ____________________________________
Title _______________________________________________________ Nickname _______________________________
Institution ____________________________________________________________________________________________
Address _____________________________________________________________________________________________
City ___________________________________________________ State _____________ Zip _______________________
Phone _________________________________________________ Fax _________________________________________
Email _________________________________________________ Website ______________________________________
Designated Delegate ___________________________________________________________________________________
(authorized person to vote for the institution)
NOTICE:
·
Dues paid to the Career College Association are not tax deductible as charitable contributions for income tax purposes. However, they may be deductible
as ordinary and necessary business expenses subject to restrictions imposed by Sec. 162(e) of the tax code as a result of association lobbying activities.
The deductible portion of your 2002/2003 dues allocable to lobbying is estimated to be 20%.
