FCCAM Professional Membership Application
FCCAM welcomes all of Maine’s legally operating Family Child Care Providers and their staff to join us in our goal of the achieving the highest standards in Maine’s diverse legal family child care homes promoting the physical, intellectual, emotional, and social development of the children in our care.
Name (First, Last)
Primary Phone Number (include area code)
Years of child care experience or year started in field?
Name of Program
Type of Program
Licensed Family Child Care
Licensed Small Facility (Licensed for 12)
Licensed Exempt (in-home 2 or less children)
Do you have employees and if so how many?
What age groups do you work with?
Is your program registered on Maine's Quality Rating System?
If yes, what is your current quality rating?
Please Check All That Apply
Maine Roads to Quality Registry Member
CACFP Participant (Food Program)
Let's Go 5210 Participantant
Eco-Healthy Child Care Certified
Nature Explore Outdoor Classroom Certification
If a Military Provider, which branch?
Less than High School
High School Diploma
Some College Courses
State of Maine Credenial
What association benefits interest you?
Would you be interested in serving on any of FCCAM's committees?
I'm not sure what those committees do, so I would like more information please.
Not at this time, thank you.
Social Media Preference
I do not use any of these
Class A Membership Fee (annual)
Individual Licensee - $25
Staff - $15 (employing licensee must be a member)
Licensed Exempt - $25
Through the generous support of MRTQ a Basic membership to our national affiliate, National Association for Family Child Care (NAFCC) at this time is only $10. This is for new NAFCC members only. FCCAM will submit all required NAFCC membership paperwork.
Yes, I would like to become a member of NAFCC for only $10 (normally $45).
Thank you, but I am already a member of NAFCC.
No thank you, not at this time.
I will mail a check to FCCAM, Attn: Sasha Shunk 70 Frost St. Portland, ME 04102
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