ࡱ> Y hbjbj[[ {9 \9 \1 ^^    l 8tr$%%%%)*)) X7Z7Z7Z7Z7Z7Z7$:=~7 4() 4 4~7^^%%;8555 4.^l%%X75 4X755,5%$gN45D7Q8085}>5R}>5}>5),*5/0Q)))~7~7j5R)))8 4 4 4 4}>))))))))) > $: Kelly Wuest 8778 South Maryland Parkway, Ste 115 Administrator Las Vegas, NV 89123 kdwuest@nvdetr.org 702.486.7330 (Phone) 702.486-7340 (Fax) Commission on Postsecondary Education Dear Applicant: Prior to operating a postsecondary educational institution in Nevada, you must first obtain licensure from the Commission on Postsecondary Education. To begin the process, you must complete the attached application and submit it to this agency. The Commission meets once each quarter (February, May, August and November) to hear initial licensure applications and conduct regular business. To be considered eligible for a specific meeting, the application must be received at least 60 days prior to the meeting. Only complete, typed applications received on or before the deadline will be considered eligible for the subsequent meeting. Applications received after the deadline or applications that are incomplete will be delayed to a future meeting. Applications received prior to the deadline will be processed by staff in the order received and you will be notified if additional information or changes are required. Based on the application and information from other state and federal licensing authorities, a recommendation will be prepared for presentation to the Commission. You will be provided a copy of the recommendation and notified of the date, time and place of the meeting. You or a knowledgeable representative must attend the meeting to respond to any questions from the Commissioners. Bonding requirements will be determined on the number of anticipated students enrolled in the first year of operating, times the tuition, times the ratio of course length to one year. Bond amount may also be affected by actual financial statement. As you complete the components of this application, I encourage you to contact staff for assistance if you are uncertain of what is required. General Information %The information on all forms (except signatures) must be typed  no exceptions.%Do not staple, hole punch or bind in any manner any part of the application.%Keep at least one complete copy for your records.%Application fees must be in the form of a check or money order made payable to the  State of Nevada. %Fees for background investigations must be in the form of a money order made payable to the  Department of Public Safety. You may use one money order to pay for all background investigations submitted simultaneously.%You may be able to have your application placed on the agenda  with contingencies, meaning that not all initial requirements have been fulfilled. These include such requirements as posting a bond or obtaining a facility, but even upon obtaining Commission approval, you cannot operate in any manner until the contingencies are fulfilled and the institution has obtained a license to operate. Direct questions to  HYPERLINK "mailto:Kdwuest@nvdetr.org" Kdwuest@nvdetr.org or 702-486-7330. Return completed applications to: Commission on Postsecondary Education 8778 S Maryland Parkway Suite 115 Las Vegas, NV 89123 You may not operate, advertise, recruit or enroll students until the application process has been completed and a license issued. ACCREDITED DEGREE GRANTING INITIAL LICENSURE CHECKLIST All information must be typed. Use this checklist. Return this checklist with the application.PROPOSED NAME OF SCHOOL WEB URL MAILING ADDRESS OF CONTACT PHONE NUMBER OF CONTACT EMAIL ADDRESS OF CONTACT ADDRESS OF SCHOOL (IF KNOWN) PHONE # OF SCHOOL IF KNOWN FAX NUMBER OF SCHOOL IF KNOWN INITIALSFORM#FORM TITLE10PRIVATE POSTSECONDARY EDUCATIONAL INSTITUTION BOND*20BUDGET ESTIMATE20aRELEASE FOR SUBSTANTIATION OF FINANCIAL DATA20bFINANCIAL INVESTOR IDENTIFICATION30CURRICULUM ATTACHMENTS/INSTRUCTIONS30jPROGRAM DESCRIPTION30kCURRICULUM CONTENT30cDISTANCE EDUCATION30dDISTANCE EDUCATION COURSES40DIRECTOR **40aACADEMIC DIRECTOR2 **40bINSTRUCTOR **40cBACKGROUND INVESTIGATION **50ATTACHMENTS AND CERTIFICATIONS60OWNERSHIP70CATALOG APPROVAL CHECKLIST (ATTACH CATALOG)70aCONTRACT APPROVAL CHECKLIST (ATTACH COPY OF ENROLLMENT AGREEMENT)80ACCREDITATION/LICENSUREReviewed or audited financial statement, prepared and signed by a certified public accountant within 12 months before the date of this application. The statement must be submitted with the application or your application WILL BE DELAYED.Two thousand dollar ($2,000) non-refundable application fee payable to the STATE OF NEVADA TREASUERLetter from accrediting body listing all prior approved curriculum/programs and indicating awareness of the Nevada applicationOne fingerprint card and a $36.25 money order payable to Department of Public Safety for each form 40b submitted if not taken electronically by a DPS-approved agency.*Retain bond form (10) until actual amount is determined by the Commission and you are notified. NOTE: Surety bond MUST BE executed by an agent licensed and residing in Nevada. (NRS 394.480) ** Can be contingent at time of application. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED FOR THE UPCOMING MEETING  SEQ CHAPTER \h \r 1PRIVATE POSTSECONDARY EDUCATIONAL INSTITUTION LICENSE BOND (10) KNOW BY ALL THOSE PRESENT THAT AS PRINCIPAL, NAME OF POSTSECONDARY EDUCATIONAL INSTITUTIONBOND NUMBERADDRESSCITY/STATE/ZIPANDNAME OF SURETY COMPANYHOME OFFICE ADDRESSCITY/STATE/ZIP as Surety, are held and firmly bound unto the STATE OF NEVADA, Commission on Postsecondary Education, in the sum of ___________________________________ DOLLARS, for the payment of which sum, well and truly be made, we bind ourselves, our successors and assigns, jointly and firmly by these present. THE condition of this obligation is such that whereas Principal is desirous of obtaining a license to operate a Private Postsecondary Educational Institution pursuant to the provisions of Nevada Revised Statutes Chapter 394, as amended and the rules and regulations of the Commission on Postsecondary Education adopted pursuant thereto, commencing on _____________________, 20_____. NOW, THEREFORE, if the above bounden Principal shall faithfully comply with all of the provisions of said statutes, rules and regulations and amendments, this obligation shall be null and void; otherwise to remain in full force and effect. This bond is provided by the Principal and surety pursuant to the provisions of Nevada Revised Statutes Chapter 394 and rules and regulations of the Commission on Postsecondary Education, and amendments of such statutes or rules and regulations in effect during the life of this bond. The requirements of such statutes, rules and regulations, or amendments thereto, and the terms, conditions and provisions thereof are and shall be deemed incorporated in and made a part of this bond as though fully set forth herein. The surety herein reserves the right to withdraw as such surety except as to any liability already incurred or accrued hereunder, and may do so upon the giving of written notice of such withdrawal to the Commission on Postsecondary Education; provided, however, that no withdrawal shall be effective for any purpose until thirty (30) days have elapsed from and after the receipt of such notice by said Commission on Postsecondary Education and further provided that no withdrawal shall in any way affect the liability of said surety arising out of the obligation herein created prior to the expiration of such period of thirty (30) days. UPON notice by the Commission on Postsecondary Education with supporting evidence to Surety of claims against Principal, Surety is held to resolve such claims within a sixty (60) days period from date of notice by the Commission on Postsecondary Education. IN WITNESS THEREOF, the Principal and said surety have hereunto caused this instrument to be executed at ________________________________________________________ this _______ day of ____________________, 20____. PRINCIPAL (NAME OF POSTSECONDARY EDUCATIONAL INSTITUTIONSIGNATURE OF OWNER/DATENAME OF SURETY COMPANYSIGNATURE OF SURETY COMPANY REPRESENTATIVE STATE OF _____________________________________} County ________________________________________} ON this _________ day of ______________, 20____,before me, ____________________________, a Notary Public in and for said County and State, personally appeared ___________________________________________, known to me to be the person whose name is subscribed to the within instrument as Attorney-in-fact of the ____________________________, and acknowledged to me that he subscribed the name of said company thereto as Principal, and his own name as Attorney-in-fact. IN WITNESS THEREOF, I have hereunto set my hand and affixed my official seal at my office, in said County and State, this _______ day of _________________, 20____. _____________________________________________ Notary Public SEAL: BUDGET ESTIMATE (20) SCHOOL NAME INCLUSIVE DATES OF ESTIMATE FOR ANY 12-MONTH PERIOD PROJECTED INCOMEPROJECTED EXPENDITURESCASH ON HAND$PERSONNELTUITION INCOMESTAFF POSITION TITLE SALARY $Program Title#EnrollTuition $Total $$$$$$$$$$SUBTOTAL STAFF$SUBTOTAL$INSTRUCTORSOTHER INCOMEProgram Title# Instr Salary $SourceAmount $$$$$$$SUB TOTAL INSTRUCTORS$SUBTOTAL$INSTRUCTIONAL MATERIALSTOTAL ESTIMATED INCOME$BOOKS$EQUIPMENT$SUPPLIES$OTHER$SUBTOTAL INSTRUCTIONAL MATERIALS$FACILITIESOPERATION$MAINTENANCE$REMODELING$RENT/CAPTIAL$OUTLAY$OTHER$SUBTOTAL FACILITIES$SERVICESADVERTISING$INSURANCE$BONDING$LIABILITIES$OTHER$SUBTOTAL SERVICES$OTHER EXPENSE$TOTAL EXPENDITURES$ RELEASE FOR SUBSTANTIATION OF FINANCIAL DATA (20a) FULL NAME OF SCHOOL OWNERNAME OF SCHOOL 1.I hereby authorize and request, for a period of six months from the date above, all persons to whom this request is presented having information relating to my financial condition, to furnish such information to an employed agent of the Nevada Commission on Postsecondary Education (CPE). 2.If the person to whom this request is presented is a brokerage firm, bank, savings and loan, other financial institution, or officer of same, I hereby authorize and request that an employed agent of CPE be permitted to review and copy such information as is used in determining assets and liabilities of an individual or corporation and the financial solvency of such an individual or corporation.3.I do hereby make, constitute and appoint any employed agent of CPE my true and lawful attorney in fact for me in name, place and stead, and on my behalf and for my use and benefit:a.To request, review and copy or otherwise act for financial investigative purposes with respect to documents and information in the possession of the person to whom this request is presented as I might or could do if personally present.b.To name the person or entity to whom this request is presented and to insert that person's name in the appropriate location on this request.c.To place the name of the CPE agent presenting this request in the appropriate location on this request.4.I have filed with CPE an "application" as that term is defined in the Nevada Revised Statutes (NRS) Chapter 394 and Nevada Administrative Code (NAC) Chapter 394 for licensure of a private postsecondary educational institution. I understand that I am seeking the granting of a privilege and acknowledge that the burden of proving my qualifications, including my financial soundness and stability, for a favorable determination, is at all times on me.5.I agree to indemnify and hold harmless the person to whom this request is presented and his agent and employees, from and against all claims, damages, losses, and expenses, including reasonable attorney fees arising out of or by reason of complying with this request.6.I understand that I am afforded all due process and appeal rights as are described in NRS and NAC Chapters 394.7.A reproduction of this request by electronic copier or similar process shall be as valid as the original.NAME OF BANKNAME AND PHONE NUMBER OF BANK CONTACTADDRESS OF BANKACCOUNT NUMBER IN WITNESS WHEREOF, I have executed this request in the COUNTY of _______________________, in the STATE of ____________________, on this ______ day of _____________, in the year of ________. __________________________________________________________ SIGNATURE OF APPLICANT/OWNER Signature witnessed by NOTARY PUBLIC on this _______ day of ______________, in the year of __________. NOTARY SIGNATURE AND SEAL: _________________________________________________________________________ CPE USE ONLY _________________________________________________ SIGNATURE OF CPE REPRESENTATIVE/DATE FINANCIAL INVESTOR IDENTIFICATION (20b) NAME OF INSTITUTION ADDRESS OF INSTITUTIONNAME OF APPLICANT/CONTACT ADDRESS OF APPLICANT/CONTACTPHONE NUMBER EMAIL ADDRESSNAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTED NAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTEDNAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTEDNAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTEDNAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTEDNAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTEDNAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTEDNAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTEDNAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTEDNAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTEDNAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTEDNAME OF INVESTOR MAILING ADDRESS PHONE AMOUNT INVESTED  SEQ CHAPTER \h \r 1CURRICULUM ATTACHMENTS/INSTRUCTIONS (30)  Forms: Form 30 Initial or check each box below as you complete the required items. Form 30J Complete the form 30J for each program you offer. Form 30K Include a listing of each course, prerequisites and credit and/or clock hour count  What you must submit: Two copies of each Form 30J and Form 30K. A copy of your attendance sheet and a description of how it will be used. A copy of student progress reports. A copy of the academic transcript which must include, as a minimum, the information found in NAC 394.353. Certificate to be awarded to student upon completion.  Additional Information: Copy of the Accreditation approval for the program. PLEASE NOTE: No application will be considered for the agenda if the curriculum submitted is incomplete or is returned disapproved. DEGREE COMPLETION REQUIREMENTS (30J) Complete this form for each program you are requesting approval to offer. You may use any format that includes the same information as this form. COLLEGE or UNIVERSITY NAMEPROGRAMMATIC ACCREDITING BODY (if applicable)NAME OF PROGRAMTOTAL CREDITS REQUIREDCOST PER CREDITENTRANCE REQUIREMENTSMIN AGEHS/GED?ADMISSIONS TEST? (IF YES, TITLE & MINIMUM SCORE)OTHER (SKILLS, PRIOR CREDIT, ETC.)LIST ALL EACH REQUIRED COURSE TITLECREDITSTITLECREDITS COURSE CONTENT FORM 30K Complete this form for each course required to complete the program listed on the 30J. PROGRAM TITLE COURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTIONCOURSE TITLECREDITSDESCRIPTION DISTANCE EDUCATION (30c) If any course work is offered via distance education, complete this form and attached a list of each course offered via distance education. LIST OF ALL EQUIPMENT?SOFTWARE USED TO OFFER DISTANCE EDUCATIONOVERVIEW OF THE DISTANCE EDUCATION PROCESS HOW ARE STUDENTS MONITORED AND HOW IS PROGRESS DETERMINED?LIST TRAINING PROVIDED TO DISTANCE EDUCATION INSTRUCTORS:DESCRIBE HOW STUDENT ATTAINMENT OF OBJECTIVES IS MEASURED:DESCRIBE HOW TESTS ARE SAFEGUARDED:DESCRIBE HOW STUDENTS ARE POSITIVELY IDENTIFIED PRIOR TO TESTING:DESCRIBE HOW TEST PROCTORS ARE SELECTED, TRAINED AND MONITORED: DISTANCE EDUCATION PROGRAMS OFFERED (30f) Degree Granting LIST ALL PROGRAMS OFFERED VIA DISTANCE EDUCATION School NameAddressSchool Representative ContactEmailTelephone Program or Degree NameOnlineOnline LiveHybridCourse Name and Number Offered - Distance Education Program or Degree NameOnlineOnline LiveHybridCourse Name and Number Offered - Distance Education Program or Degree NameOnlineOnline LiveHybridCourse Name and Number Offered - Distance Education CPE Licensing Use OnlyApprovedDisapproveCatalog/Addendum SubmittedEffective Date DIRECTOR (40) Complete this form for the director (manager) of the private postsecondary educational institution NAC 394.480. NAME OF DIRECTORPHONE NUMBERNAME/ADDRESS OF SCHOOLWEB SITE OF SCHOOLEMAIL ADDRESS OF DIRECTORCHARACTER REFERENCESNAMEPHONE NUMBER % PROFESSIONAL % PERSONALNAME PHONE NUMBER % PROFESSIONAL % PERSONALNAME PHONE NUMBER % PROFESSIONAL % PERSONAL Attach the following: % Evidence of Nevada residency (drivers license, voter registration, lease or rent agreement, etc.) % Evidence of two years of administrative experience in an accredited institution of higher learning. I certify that % I have received a copy of and am familiar with NRS 394 and NAC 394. % I am a bona fide resident of Nevada. % The information on this form and those attached are true and correct. SIGNATURE OF APPLICANT/DATE ACADEMIC DIRECTOR (40a) Complete this form for the academic director of each licensed program  NAC 394.480. NAME OF SCHOOLNAME OF ACADEMIC DIRECTORPROGRAMS ASSIGNED TO THIS ACADEMIC DIRECTOR:HIGH SCHOOL ATTENDEDCITY/STATEDATE COMPLETEDPOSTSECONDARY SCHOOLCITY/STATEAREA OF STUDYAWARD/DATEPOSTSECONDARY SCHOOLCITY/STATEAREA OF STUDYAWARD/DATEPAST EMPLOYER/ADDRESS/PHONE #JOB TITLEINCLUSIVE DATESPAST EMPLOYER/ADDRESS/PHONE #JOB TITLEINCLUSIVE DATESPAST EMPLOYER/ADDRESS/PHONE #JOB TITLEINCLUSIVE DATESNAME OF CHARACTER REFERENCEPHONE NUMBER % PROFESSIONAL % PERSONALNAME OF CHARACTER REFERENCE PHONE NUMBER % PROFESSIONAL % PERSONALNAME OF CHARACTER REFERENCE PHONE NUMBER % PROFESSIONAL % PERSONAL Note: Instructor qualifications differ based on the level of instruction. See NAC 394.485 for exact requirement. Attach the following: % High school diploma or postsecondary degree obtainment and; % Evidence of two years of work or teaching experience in the subject assigned; or, % Evidence of a bachelor degree in a field related to assigned courses if assigned undergraduate academic degree; or % Evidence of a master degree in a field related to assigned courses if assigned master degree; or, % Evidence of doctorate degree in a field related to assigned courses if assigned doctorate degree. I certify that the information on this form and those attached are true and correct. SIGNATURE OF APPLICANT/DATE INSTRUCTOR (40b) Complete this form for each instructor and attach required documents  NAC 394.485. INSTRUCTOR NAMEDATE HIREDNAME OF SCHOOLLIST ALL COURSES/SUBJECTS ASSIGNED TO TEACH ELABORATE ON ANY ACRONYM: CHECK BELOW AS APPLICABLE AND SUBMIT COPIES OF THE REQUIRED DOCUMENTS (RETAIN ORIGINALS):Instructor is assigned to teach non-degree granting courses, classes or subjects. Attach letters from previous employers indicating at least two years of teaching or work experience for each course, class or subject assigned to teach. The letters must describe the work or teaching responsibilities in detail and provide contact information to verify employment. Attach evidence of completion of high school, equivalent or postsecondary education. Provide documentation of any credential/license required to teach assigned subject.Instructor is assigned to teach technical courses at the associate-degree level. (Example: MicroSoft Access for students enrolled in an Associate program.) Attach letters from previous employers indicating at least two years of teaching or work experience for each course, class or subject assigned to teach. The letters must describe the work or teaching responsibilities in detail and provide contact information to verify employment. Attach evidence of completion of high school equivalent or postsecondary education. Provide documentation of any credential/license required to teach assigned subject.Instructor is assigned to teach undergraduate degree granting courses, classes or subjects. Attach an official academic transcript from an accredited postsecondary educational institution indicating the award of a bachelors degree related to the assigned courses. Provide documentation of any credential/license required to teach assigned subject.Instructor is assigned to teach graduate degree granting courses, classes or subjects. Attach an official academic transcript from an accredited postsecondary educational institution indicating the award of a masters degree related to the assigned courses. Provide documentation of any credential/license required to teach assigned subject.  SEQ CHAPTER \h \r 1Background Investigation Requirements As of July 1, 2014, the process for submitting fingerprints to the Commission must be as described below. Any fingerprint application that does not follow the process below will be rejected and considered not to be in compliance with NRS 394.465, subjecting the school to fines. Process If Taken By Law Enforcement (Manually) Step 1Obtain and complete HYPERLINK "http://www.cpe.state.nv.us/Form/40c-Background%20New.doc"CPE Form 40c. The form must be signed by both the applicant and a school official.Step 2Mail or bring the completed  HYPERLINK "http://www.cpe.state.nv.us/Forms/40c-Background%20New.doc" CPE Form 40c to the Commission on Postsecondary for initial processing. CPE Staff must sign the form prior to Step 3.Step 3Haven finger prints taken by law enforcement. The completed fingerprint card MUST be placed into an envelope, sealed, and initialed by the agency taking the prints.Step 4Return the sealed envelope and a money order or company check for $36.25 (Starting October 1, 2016) (made payable to the Department of Public Safety), to: CPE 8778 S Maryland PW Ste 115 Las Vegas, NV, 89123 Process If Taken By and Submitted Electronically Step 1Obtain and complete  HYPERLINK "http://www.cpe.state.nv.us/Form/40c-Background%20New.doc" CPE Form 40c. The form must be signed by both the applicant and a school official.Step 2Mail or bring the completed CPE  HYPERLINK "http://www.cpe.state.nv.us/Form/40c-Background%20New.doc" Form 40c to the Commission on Postsecondary for initial processing. CPE Staff must sign the form prior to Step 3.Step 3Prints must be taken by a Department of Public Safety approved vendor.  HYPERLINK "http://nvrepository.state.nv.us/Fingerprint/forms/fingerprint_sites.pdf" Click here for a list of approved vendors.Step 4Ensure vendor completes SECTION 4 of CPE Form 40c.Step 5Return the ORIGINAL completed form to CPE. CPE Form 40c Background Investigation SECTION 1/FINGERPRINT BACKGROUND WAIVER APPLICANTS LAST NAME (PRINT LEGIBLY) APPLICANTS FIRST NAME POSITION AT SCHOOL APPLICANTS ADDRESS APPLICANTS CITY/ST/ZIP APPLICANTS HOME OR CELL PHONE # LIST ALL FELONY OR CRIMES OF MORAL TURPITUDE CONVICTIONS. USE ADDTIONAL PAPER IF NEEDED. IF NONE, WRITE NONE IN YEAR FIELD. YEAR CITY/STATE CONVICTED OF SENTENCE As an applicant who is the subject of a Federal Bureau of Investigation (FBI) fingerprint-based criminal history record check for a noncriminal justice purpose you have certain rights which are discussed below. 1. You must be notified by the Commission on Postsecondary Education that your fingerprints will be used to check the criminal history records of the FBI and the State of Nevada. 2. If you have a criminal history record, the officials making a determination of your suitability for the job, license or other benefit for which you are applying must provide you the opportunity to complete or challenge the accuracy of the information in the record. You may review and challenge the accuracy of any and all criminal history records which are returned to the submitting agency. The proper forms and procedures will be furnished to you by the Nevada Department of Public Safety, Records Bureau upon request. If you decide to challenge the accuracy or completeness of you FBI criminal history record, Title 28 of the Code of Federal Regulations Section 16.34 provides for the proper procedure to do so: 16.34 - Procedure to obtain change, correction, or updating of identification records. If, after reviewing his/her identification record, the subject thereof believes that it is incorrect or incomplete in any respect and wishes changes, corrections or updating of the alleged deficiency, he/she should make application directly to the agency which contributed the questioned information. The subject of a record may also direct his/her challenge as to the accuracy or completeness of any entry on his/her record to the FBI, Criminal Justice Information Services (CJIS) Division ATTN: SCU, Mod. D-2, 1000 Custer Hollow Road, Clarksburg, WV 26306. The FBI will then forward the challenge to the agency which submitted the data requesting that agency to verify or correct the challenged entry. Upon the receipt of an official communication directly from the agency which contributed the original information, the FBI CJIS Division will make any changes necessary in accordance with the information supplied by that agency. 3. Based on 28 CFR 50.12 (b), officials making such determinations should not deny the license or employment based on information in the record until the applicant has been afforded a reasonable time to correct or complete the record or has declined to do so. 4. You have the right to expect that officials receiving the results of the fingerprint-based criminal history record check will use it only for authorized purposes and will not retain or disseminate it in violation of federal or state statute, regulation or executive order, or rule, procedure or standard established by the National Crime Prevention and Privacy Compact Council. 5. I hereby authorize Commission on Postsecondary Education to submit a set of my fingerprints to the Nevada Department Public Safety, Records Bureau for the purpose of accessing and reviewing State of Nevada and FBI criminal history records that may pertain to me. In giving this authorization, I expressly understand that the records may include information pertaining to notations of arrest, detainments, indictments, information or other charges for which the final court disposition is pending or is unknown to the above referenced agency. For records containing final court disposition information, I understand that the release may include information pertaining to dismissals, acquittals, convictions, sentences, correctional supervision information and information concerning the status of my parole or probation when applicable. 6. I hereby release from liability and promise to hold harmless under any and all causes of legal action, the State of Nevada, its officers, agents and/or employees who conducted my criminal history records search and provided information to the submitting agency for any statement(s), omission(s), or infringement(s) upon my current legal rights. I further release and promise to hold harmless and covenant not to sue any persons, firms, institutions or agencies providing such information to the State of Nevada on the basis of their disclosures. I have signed this release voluntarily and of my own free will. A reproduction of this authorization for release of information by photocopy, facsimile or similar process, shall for all purposes be as valid as the original. In consideration for processing my application I, the undersigned, whose name and signature voluntarily appears below; do hereby and irrevocably agree to the above. SIGNATURE OF APPLICANTDATE SIGNEDSECTION 2/SCHOOL INFORMATIONNAME OF SCHOOLPRINTED NAME OF SCHOOL OFFICIALSCHOOL OFFICIALS POSTIONSCHOOL OFFICIALS PHONE NUMBERI certify that I have reviewed the information on this form as provided by the applicant. SIGNATURE OF SCHOOL OFFICIAL/DATE SIGNED  SECTION 3/CPE INFORMATIONCommission on Postsecondary Education 8778 S Maryland PW #115 Las Vegas NV 8912PRINTED NAME OF CPE STAFFSIGNATURE OF CPE STAFFSECTION 4/ENTITY TAKING FINGERPRINTS (Do not process without CPE signature and stamp)STAMP/SIGNATURE OF ENTITY TAKING AND SUBMITTING FINGERPRINTS DATETCN #Completed form can be returned to sbeckett@nvdetr.org  SEQ CHAPTER \h \r 1 ATTACHMENTS AND CERTIFICATIONS (50) Include the following documents with this form if available.Copy of all proposed advertising for the institution, including radio script, video/film tapes, phone book and newspaper advertisements, and all telemarketing script.Lease agreement, proof of ownership, or agreement signed by the owner of the institution's training facility and a line drawing or blue prints which show the length and width of each room within the training facility.*Copy of the business license and/or certificate of occupancy.** May be submitted after Commission approval but must be submitted prior to issuance of a license to operateInitial each box that the applicant attest to the following requirements. I certify that I have received copies of the Nevada Revised Statutes Chapter 394 and codified regulations (Nevada Administrative Code Chapter 394) and that if licensed, I hereby agree to operate the postsecondary educational institution described in this application in full compliance with all applicable statutes, regulations, and commission policies.I declare that the postsecondary educational institution described in this application is in full compliance with the civil rights act as amended (Title VI) and the Americans with disabilities act and that the institution will in no way discriminate on the basis of race, color, creed, age, sex, or disability.In the event of discontinuing operation of this postsecondary educational institution, I hereby agree to submit the academic records of all students to the Nevada Commission on Postsecondary Education and all records of any students who have not completed their training at the time of closure.As an authorized representative of the postsecondary educational institution described in this application, I hereby certify that the information provided on this form and the attachments hereby submitted are complete and accurate.PRINTED/TYPED NAME OF SCHOOL REPRESENTATIVESIGNATURE AND DATE SIGNED OWNERSHIP (60) Complete applicable section listing all entities having any financial investment. Attach requested forms & additional pages as needed. SCHOOL NAMESOLE PROPRIETORSHIP Individual owner/spouse. Financial statement demonstrating ownership and fictitious firm name. Submit registration with Secretary of State.NAME OF OWNERAREA CODE & PHONE NUMBER EMAIL ADDRESSFULL MAILING ADDRESS NAME OF BUSINESSPHONE NUMBERBUSINESS ADDRESSWEB URLPARTNERSHIP Submit a copy of partnership agreement and list all partners and/or any entity having any financial investment. Submit registration with Secretary of State.NAME OF PARTNERSHIPADDRESSPHONE NUMBER WEB URL PARTNER NAMEADDRESSPHONE NUMBERPARTNER NAMEADDRESSPHONE NUMBERPARTNER NAMEADDRESSPHONE NUMBERCORPORATION List all entities having a 10% or more interest. Attach articles of incorporation, corporation certificate and include a listing of all officers. Submit registration with Secretary of State.NAME OF CORPORATIONADDRESSPHONE NUMBERWEB URLCORPORATE OFFICER/POSITIONADDRESSPHONE NUMBERCORPORATE OFFICER/POSITIONADDRESSPHONE NUMBERCORPORATE OFFICER/POSITIONADDRESSPHONE NUMBERLIMITED LIABILITY COMPANY including Professional LLC & Foreign LLC Submit articles of organization and listing of manager /members. Submit registration with Secretary of State. NAME OF LIMITED LIABILITY COMPANYADDRESSPHONE NUMBER WEB URL MANAGER OR MEMBERADDRESSPHONE NUMBERMANAGER OR MEMBERADDRESSPHONE NUMBERPUBLIC INSTITUTION Attach a copy of your state charter. SIGNATURE OF OWNER or REPRESENTATIVE PRINTED NAME OF OWNER or REPRESENTATIVEDATE CATALOG APPROVAL CHECKLIST (70) Enter the page number for each of the following items and return it with two copies of your catalog. Refer to NRS 394.441, 449, 4493 and NAC 394.605. 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Briefly describe each course to show objective, content, and length, in hours or credits. If applicable, list and describe all special classes or courses.   CPE USE ONLY  DEFICIENCIES/COMMENTSSIGNATURE OF REVIEWER/DATE ENROLLMENT AGREEMENT CHECKLIST (70a) Items below are required by NAC 394.610. Initial or check each item indicating it is on the enrollment agreement. School Identification InformationNameAddressPhone numberSignature/date block Student Identification InformationStudent nameStudent addressStudent phone numberStudent signature/date blockStatement RequirementsEffective date of catalog under which the student is enrolledStatement in bold print that the person signing the enrollment agreement understands it and has received a copy of the catalog or brochure and understands it is part of the enrollment agreementProgram InformationFull name of degree including level of award (Bachelor of Science, Master of Arts, etc.)  CPE USE ONLY  DEFICIENCIES/COMMENTSSIGNATURE OF REVIEWER/DATE ACCREDITATION/LICENSURE (80) If you currently operate a school in any other location, check all that apply and complete this form. Section I If you are applying for initial licensure and currently operate an accredited school in another location, purchasing an accredited school, or adding a new program to a licensed school that is accredited, you must:INITIALSAttach a letter from your accrediting body listing all accredited programs and indicating you are in good standing, that they are aware of this application, and that the programs contained in this application are accredited.Attach a letter from the state or municipality that authorizes your operation stating you are in good standingAttach a copy of all licenses issued to operateComplete section II below List most recent cohort default rates as published by the US Dept of Education:Year: Rate:Year: Rate: Year: Rate:If you are applying for initial licensure and currently operate a school in another location, you must:INITIALSAttach a letter from the state or municipality that authorizes your operation stating you are in good standingAttach a copy of all licenses issued to operateComplete Section II below If you operated or were affiliated with a school in any location that closed, you must:INITIALSAttach a letter from the licensing authority detailing the circumstances of the closure, indicating if it was done within their guidelines, if students were taught out or refunded and to what extent the closed school assisted.Section IINAME OF PROGRAMINCLUSIVE DATES# ENROLLED# COMPLETED# DROPPEDPLACED*TITLE IV**NAME OF PROGRAMINCLUSIVE DATES# ENROLLED# COMPLETED# DROPPEDPLACED*TITLE IV**NAME OF PROGRAMINCLUSIVE DATES# ENROLLED# COMPLETED# DROPPEDPLACED*TITLE IV**NAME OF PROGRAMINCLUSIVE DATES# ENROLLED# COMPLETED# DROPPEDPLACED*TITLE IV*** Count only individuals employed in positions directly related to the training ** Count all who used any type of Title IV program JOLONOQ}} $If]gdRukd*$$Ifs0*%0*64 sasPPQQQQQQQQQQQQQQR6R$$IfO40u)*%0(4+4saf4^^^^}} $IfgdRxkd>$$IfO40u)*%0(4+4saf4^^^_}} $IfgdRxkd~?$$IfO40u)*%0(4+4saf4________}}}}}} $IfgdRxkd"@$$IfO40u)*%0(4+4saf4___:1 $IfgdRkd@$$IfO4ֈ& IQ"u)g@?0(4+4saf4__``&jkdpB$$IfO4u)(0(2 4+4saf4 $IfgdRekdA$$IfO4u)(0(4+4saf4``aaa bn{kdC$$IfO40u)*%0(4+4saf4yt  $IfgdR $$Ifa$gdR b"b$bXb}} $IfgdRxkdC$$IfO40u)*%0(4+4saf4XbZb\b^b}} $IfgdRxkd]D$$IfO40u)*%0(4+4saf4^b`bcc&jkdE$$IfO4u)(0(2 4+4saf4 $IfgdRekdE$$IfO4u)(0(4+4saf4c$cddeqxkdhF$$IfO4@0u)*%0(4+4saf4 $IfgdR $$Ifa$gdRee$eDe $IfgdRekdG$$IfO4@u)(0(4+4saf4DeFe\eteeee $IfgdRukdG$$IfO@0Uu) 0(4+4saeeeePGG $IfgdRkdVH$$IfO@r{?Uu) 0(4+4saeef f4fDfZf{{{{{ $IfgdR{kdI$$IfO4@0Uu) 0(4+4saf4Zf\f|ffPGG $IfgdRkdI$$IfO@r{?Uu) 0(4+4saffffffg}}}}} $IfgdRxkd}J$$IfO4@0Uu) 0(4+4saf4gg(gHgPGG $IfgdRkdK$$IfO@r{?Uu) 0(4+4saHgJg`gxgggg}}}}} $IfgdRxkdK$$IfO4@0Uu) 0(4+4saf4ggXhhPGG $IfgdRkd{L$$IfO@r{?Uu) 0(4+4sahhhhhhhhhhhh]gdYpgdRbkd=M$$IfOu)(0(4+4sa hhhhhhhhhB6h8[hBM:&P:p 4@PBP/ =!"#z$% FX>#D!J JFIF;CREATOR: gd-jpeg v1.0 (using IJG JPEG v62), quality = 90 C     C   ,(" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?S((((i<7TrKd1 ~ O&wd&ڧ;3/ȟ&✟,Uߐ>yu:<I#U:6Jqۨߕ@E' z.ĻZnLwn!E0-b"ԏy_Sï`H˞]I "rݦtUoU_;7p,3 ~xtq ?C)Z .dhO~ZGԩ+d6}Y> =y;~Z#wHn?d$Tȯ9ilD`xvOi7_o ngwOQs| p/č%nڐ\mS?E{]BA* $lXz:UxXYj${ϾӉ⢧ e{1<p{[0ReXV?q+.Be~Wgq*%V8i۫O!:&'K^}^}3+߷OsŧY!l)u,e' +qf7.&*Op>-^Խ#JO5(((((((('W~!>mր.jxԒxI 5@k3}M$ž32s3CCo|pCo%߂< ଺ ݩ<3W:NeA8™O!8<1n0k0=9c?cK^^mshJ՞s͏">pHց/}&yޝ8,#I*/.SǽiQ9Y=$|N DR@Ҡ?ô/snc }WajG.Jc, />: sjN㺖k诱bnZX81}sQ᫁mt͞$!Fl?qW<hlXecI!p =I t[~#Zj\Lݴd$.(PKW40X_zºwȄosfYbOU'ҡWtr\\˦ak:m# Jl{)̑8'>6 r'dnR}Ɂ GVU2٦SɶsՄ78#UAt?|?6;_C~"ƭkh`nr6:_ brΆ&-Z>4TJ2:Z)4h(((()ɧ^T~՞) _c? 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