North Carolina Society of Accountants, Inc. – Membership Application
All applicants for membership must be of good moral character, apply for the highest level of membership for which they qualify, and shall pledge in writing to conform to the NCSA Rules of Professional Conduct.
You may apply online at www.ncsa1947.org/application or you can mail your application to:
NCSA Membership Committee
C/O Candace Cansler, Executive Director NCSA
Post Office Box 1126
Conover, North Carolina 28613
Full Name ________________________________________________________________________________________________________________PTIN ________________________
Address _____________________________________________________________________________________ City ______________________________________________________
State _______ Zip _____________ E-Mail Address __________________________________________________________________________________________________________
Office Phone # ______________________________________ Fax # ______________________________________ Alternate # ________________________________________
Company Name ____________________________________________________________________Position with Company _________________________________________
Are you a member of NSA? Yes ___ No ___ NCSA Local Chapter member? Yes ___ No ___ if yes, which chapter______________________________________
Questions must be answered in order to approve your application
Q1. Are you a citizen of the United States of America? Yes ____ No ____ if yes, continue to Q2A, if no, skip to Q5
Q2A. Have you completed 2 ½ years in public accounting practice and/or tax preparation? Yes ____ No ____ if yes, continue to Q3A, if no, go to Q2B
Q2B. Have you completed 5 years of service with the IRS or a State Dept. of Revenue? Yes ____ No ____ if yes, continue to Q3A, if no, go to Q5
Q3A. Do you possess a valid CPA certificate issued by the NC State Board of CPA Examiners? Yes ____ No ____ if yes, continue to Q4, if no go to Q3B
Q3B. Do you possess an “Accountant” Privilege license issued by the NC Dept. of Revenue? Yes ____ No ____ if yes, continue to Q4, if no go to Q3C
Q3C. Do you claim to only have an income tax practice, only prepare income tax returns and do not prepare financial statements? Yes ____ No ____
if yes, continue to Q4, if no go to Q5
Q4. At least one of the following must apply for Full membership in the NCSA:
Circle one that applies, provide the necessary information, you qualify for Full membership, if none go to Q5
A.) Enrolled Agent (EA) – Please provide Treasury Card # ______________________________
B.) ACAT Credential (Accreditation Council for Accountancy & Taxation) circle one or all that apply.
ABA ATA ATP ARA
C.) Associate, Bachelor, or higher degree; with at least 24 semester hours in Accounting.
Highest degree attained ________________ Year ________ College/University ____________________________
D.) Employed at least 3 years as an accountant under the direct supervision of a CPA or a Full member of NCSA.
CPA / NCSA Member Name ______________________________________________________________________
Phone # or E-Mail Address _______________________________________________________________________
E.) You have been in the public practice of accounting in excess of thirty six months (36 months)? Yes _____ No _____
Q5. Are you currently enrolled in an undergraduate college level accounting program? Yes _____ No _____ if no, you qualify for Associate
If yes, you qualify for student membership, provide college name__________________________ Projected Graduation Date _________________
Character References: All applicants must provide three (3) character references
Name Address City State Zip Phone or E-Mail
Dues and Details: Your initial dues payment in full must accompany this application, renewal dues will be billed annually on July 1st. Dues for membership: Full - $180, Associate - $120, Student - $20. Proration of dues: A members’ dues starts the month their application is approved and any credits are applied against the next fiscal year’s dues. Example: Application approved on October 21, 2016 would yield a three (3) month credit towards the next fiscal year’s dues.
Continuing Education: To maintain Full Membership in the Society, Members shall be required to have fifteen (15) hours of continuing education every year in courses which qualify under rules established by the Board of Directors of the Society.
Affirmation: I understand that all information given on this application will be held in strictest confidence. My signature will serve as authority to anyone given as a reference to answer any inquiries that NCSA may care to make in connection with my application for membership. I understand that any time I should cease to be a member, I will return my membership Certificate and Society Emblem, which remain the property of the North Carolina Society of Accountants, Inc.
Applicant Signature______________________________________________________________________________________ Date _______________________________
Sponsor Signature, if applicable _______________________________________________________________________ Date _______________________________