The regional accrediting agencies were established in the late 19th and early 20th centuries in response to a perceived need for better articulation between secondary schools and higher education institutions (the school offered the courses the college needed applicants to have taken; this helped colleges and universities evaluate prospective students). The New England Association was formed in 1885 by a group of schoolmasters of secondary schools. The Middle States Association formed in 1887. The faculty of Vanderbilt University led the establishment of the Southern Association in 1895, and the North Central Association was organized the same year at a meeting of 36 administrators of midwestern schools, colleges, and universities. The Northwest Association of Secondary and Higher Schools (predecessor of the two organizations that now serve that region) was formed in 1917 and the Western Association was founded in 1923. Initially the main focus of the organizations was on accreditation of secondary schools and establishment of uniform college entrance requirements.

Accreditation first emerged as a regional rather than national activity because it typically involved site visits, and the fastest transportation available at the time was the railroad.