NFCC International Affiliate Application Step 1 of 5 20% Thank you for your interest in taking the first step toward becoming an International Affiliate of NFCC!Before starting this initial application, please complete the Application Qualification Requirements and check each box when completed:Please review the following application qualification requirements:Operate as a charitable or nonprofit organizationMust be accredited and operating in compliance with federal and local laws and regulationsMaintain accreditation through Social Currents (formerly Council on Accreditation or COA), ISO 9001 (Bureau Veritas), or a recognized and approved industry association (ie. Credit Counselling Canada)Agree to comply with the NFCC Mission Statement & Code of Ethics and International Affiliate Quality StandardsAgree to the NFCC BylawsDownload, complete and return these items:Application fee processing form ($1,500)Save completed forms and upload them when prompted at the start of the applicationThe non-refundable International Affiliate application fee is $1,500. This covers all of the work involved with the application review and onboarding. The entire process may take six to eight weeks. Payment is by ACH or check only.Please begin the application:Today's date(Required) MM slash DD slash YYYY Applicant must review and accept the application qualification requirements (listed above).(Required) I have reviewed and accept the application qualification requirements. Please use the space below to upload the following documents before proceeding to the next section of the application.(Required)Completed application fee processing form, $1,500Articles of Incorporation and BylawsMission StatementListing of Board Directors with Names, Occupations, Time of Service on BoardMost current financial statement Most current auditFee ScheduleFee Waiver PolicyA listing of how the agency provides budgeting and credit counseling services for clients seeking assistanceA listing of education activities during last 12 months Drop files here or Select files Max. file size: 8 MB. Contact PersonThe contact person can be either a volunteer board member or a paid staff member and will serve as NFCC’s contact for questions, correspondence, and discussion during the application process.Name(Required) Street address(Required) City(Required) State/Province(Required) Postal code(Required) Phone number(Required) Email(Required) Enter Email Confirm Email AgencyProvide the name you intend to use as your operating name when approved for membership. In the event you wish to use a “Consumer Credit Counseling Service” or the “CCCS” name and mark, the use is limited by license with the NFCC and may not be available in requested areas.Agency name(Required) Doing Business As(Required) Primary Location Address(Required) City(Required) State/Province(Required) Postal Code(Required) Agency primary phone number(Required) Agency fax number(Required) Please list days and hours of operation(Required) Agency will have more than one physical service location(Required) Yes No Please provide the address of all additional physical service locations(Required)Agency website(Required) Social Media Presence(Required) (List all social media account handles) Date Business was Established(Required) MM slash DD slash YYYY What is the Legal Form of Ownership?(Required)(LLC, Corporation, etc) What is the Business Classification?(Required)(nonprofit, for-profit, etc) Please list all Association Memberships(Required)Does agency have any locations or offer any services in the United States?(Required) Yes No If yes, please provide details of locations and services provided(Required)Is the Business Accredited?(Required) Yes No If yes, enter name of accrediting body(Required)Enter here... Is your agency licensed in all areas here you do business?(Required) Yes No If yes, please list all licenses and their expiration dates.(Required)Is there any regulatory action, complaint, litigation, dispute or other adversarial event that is pending against your agency?(Required) Yes No If yes. please explain the nature of the action(Required)What services does the agency provide?(Required)How many consumers do you serve annually?(Required)How many consumers do you have currently enrolled in a Debt Management Plan (DMP) of equivalent?(Required)How often do you disburse DMP payments to creditors?(Required) Are your counselors certified?(Required) Yes No If yes, which counselor certification program do you use?(Required)Do you require certifications for all counselors?(Required) Yes No If no, please explain(Required)ComplianceThe agency is a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code.(Required) Yes No In the past ten years, has the agency been audited by the Internal Revenue Service?(Required) Yes No When did the audit begin?(Required) MM slash DD slash YYYY What is the audit status?(Required)Select...ongoingclosedresults being challengedWhen was the audit closed?(Required) MM slash DD slash YYYY Did the IRS direct the agency to take any action as part of the closing?(Required) Yes No Please specify actions required by the IRS.(Required)Has the agency been notified by the IRS that the IRS is considering revoking or otherwise challenging the Agency’s status under Section 501(c)(3) of the Internal Revenue Code?(Required) Yes No When was that notification received?(Required) MM slash DD slash YYYY What is the status of the notification?(Required) Compliance with NFCC Member Quality StandardsPlease review the NFCC Member Quality Standards prior to proceeding. NFCC Member Quality StandardsThe agency is in compliance with NFCC Member Quality Standard # 01.00: Accreditation(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 02.00: Access and Availability(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 03.00: Group Financial Literacy(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 04.00: Counseling Sessions(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 04.01: Counselors(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 05.00: Debt Management Plans(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 05.01: Model Member Agency Funding Disclosure(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 05.02: Model Member Agency Dual Role Disclosure(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 05.03: Model Member Agency DMP Duration Disclosure(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 06.00: Fiscal Integrity(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 06.01: Client Trust Accounts(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 06.02: Annual Financial Audit(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 06.03: IRS Forms 990 and 990-T(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 07.00: Governance / Board of Trustees(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 08.00: D&O, E&O and Fidelity Insurance(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 09.00: Fair Fees Guideline(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 10.00: Ethical Practices and Conduct(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 11.00: Advertising(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 12.00: Compliance with Federal, State, and Local Laws(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 13.00: Grievances(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 14.00: Private Inurement and Private Benefit(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 15.00: Reporting(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 16.00: Nepotism(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 17.00: Technology Requirements for Delivering Quality Programs(Required) Yes No If no, please comment(Required) The agency is in compliance with NFCC Member Quality Standard # 18.00: Data Security(Required) Yes No If no, please comment(Required) Certification and digital signatureDigital Signature(Required) Digital signature certification(Required)I certify, under penalty of perjury and the laws of the United States of America, that the foregoing is true and correct. 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