TEST FORM: Application Counselor Sponsoring Entity

TEST FORM: Application Counselor Sponsoring Entity Application

  • Please download and fill out the Certified Application Counselor Form and email it to: acse.cac@maryland.gov.
    Email a Letter of Support from the Connector Entity you plan to affiliate to: ACSE.CAC@Maryland.gov
    Download and complete the Non-Exchange Entity Agreement form and email it to: ACSE.CAC@Maryland.gov
    By checking this box, I am indicating my consent to electronically sign this application and warrant that all of the information I have provided is true, complete and accurate. I agree to update any change of address, phone or email within 30 days of the change. I have read, understand and will attest to the Attestation for the Certified Application Counselor Sponsoring Entity, for which I am applying. I understand that I will be required to abide by all applicable state and federal regulations.

    Download and sign the Application Counselor Sponsoring Entity Attestation and email it to: ACSE.CAC@Maryland.gov.