### 1 Section A



# Section A. Please answer these general questions.

1. Tell us why you are submitting this application. (You may check more than one box.)

Initial Certification. This is a request for initial approval to participate in federal student

financial aid programs and to be initially designated as an eligible institution for other Higher

Education Amendments (HEA) programs.

Change in institutional ownership or structure. Thi s is a request to participate in federal

student financial aid programs and to be designated as an eligible institution for other HEA

programs following a change in institutional ownership or structure.

Check here if requesting a preacquistion review.

Recertification . This is a request to continue to participate in federal student financial aid

programs and to continue to be designated as an eligible institution for other HEA programs

either in response to a recertification notice from us or because your institution’s Program

Participation Agreement (PPA) will expire soon.

Designation as an eligible institution. This is a request to be designated as an eligible

institution so that your students may receive deferments under federal student loan progr ams or

so that your institution may apply to participate in federal HEA programs other than Title IV

student financial aid programs, including the Hope and Lifetime Learning Tax Credits.

Reinstatement. This is a request to be reinstated to participate in federal student financial aid

programs and/or to be redesignated as an eligible institution for other HEA programs.

Update Information. The purpose of this application is to update information about the

institution. If you check “Update Information,” please identify at least one purpose.

Other (specify)

2. What is the name of your institution?

### 2 Section A

3a. Do you have another name such as a trade name or a d/b/a name, under which you legally do

business as a postsecondary educational institution?

Yes No

If yes, what is that name?

3b. During the last 4 years, have you had another name that you have not previously reported

to the Department of Education?

Yes No

If yes, what is that name?

4. Check here if you are an institution resulting from a merger in the past four years

that you have not previously reported to the Department of Education, and give the

names, TIN Numbers, and OPE ID numbers of the former (pre

- merger) institutions.

( You must enter the merger date in Question 19 (Section C)).

OPE ID Name TIN

5. What is your 8 digit OPE ID Number? (Enter the first 6 digits. The final 2 digits are entered for you.)

Check here if you are an initial applicant and do not have an OPE ID number, and go to

Question 6.

Current OPE ID (or former OPE ID if seeking reinstatement)



### 00

### 3 Section A

6a. What is your 9

- digit Tax Identification Number (TIN) assigned by the IRS?

6b. What is your 9

- digit DUNS number?

7. What was your most recently completed award year?

Beginning date: 07/01/____

Ending date: 06/30/____

8

. What is your current award year?

Beginning date: 07/ 01/____

Ending date: 06/30/____

9

. (Optional) Does your institution have a website (or home page) on the Internet?

Yes No

If yes, list the electronic address (URL).

10. Who is your chief executive officer (CEO)/president/chancellor?

First name, MI , Last name , Suffix

(include prefix, such as Mr., Ms., Dr.)

Job T itle

Business street address

City

### 4 Section A

State and Z ip+4 ( or Foreign Province, Postal Code, and C ountry, if outside the U.S.)

Telephone number (including area code)

ext:

Fax number (including area code)

ext:

E

- mail address

11. Who is your chief fiscal officer/financial officer?

First name, MI , Last name , Suffix

(include prefix, such as Mr., Ms., Dr.)

Job T itle

Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and C ountry, if outside the U.S.)

Telephone number (including area code)

ext:

Fax number (including area code)

ext:

### 5 Section A



### E

- mail address

12. Who is your chief financial aid director?

NOTE: This must be a capable individual designated to be responsible for administering all the Title IV, HEA programs

and coordinating those programs with the institution's other Federal and non

- Federal programs of student financial

assistance.

(See 34 CFR 668.16)

First name, MI , Last name , Suffix

(include prefix, such as Mr., Ms., Dr)

Job T itle

Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

Telephone number (including area code)

ext:

Fax number (including area code)

ext:

E

- mail address

### 6 Section A



### 13. To whom do you wish us to send publications (such as the FSA Handbook) and printed communications

concerning federal student financial aid?

Check here if this is the s ame person as in Question 10.

Check here if this is the s ame person as in Question 12.

If neither of these people, complete the information below.

First name, MI , Last name , Suffix

(include prefix, such as Mr., Ms., Dr.)

Job T itle

Mailing address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

Telephone number (including area code)

ext:

Fax number (including area code)

ext:

E

- mail address

### 7 Section A

14. Whom should we contact if we have questions about information in this form? ( Note: If there is

someone you wish us to contact outside of your institution, you may enter them in question 70.)

Check here if this is the s ame person as in Question 10.

Check here if this is the s ame person as in Question 12.

If n either of these people, complete the information below.

First name, MI , Last name , Suffix

(include prefix, such as Mr., Ms., Dr.)



### Job T itle

Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)



### Telephone number (including area code)

ext:

Fax number (including area code)

ext:

E

- mail address

### 8 Section B



# Section B. Please tell us about your accreditation

and state authorization to provide

postsecondary education.

Check here if you are a foreign institution (including foreign graduate medical schools), and go to

Section C

.

15. What is your accrediting agency?

If you have institution

- wide accreditation, provide the following information for each agency. If more than

one accrediting agency provides accreditation, designate the one you wish us to use in determining your

eligibil ity and continued eligibility (the Primary accreditor)

.

If you do not have institution

- wide accreditation, provide the following information for each accrediting

agency that either accredits a program that is currently eligible or for which you are seekin g eligibility.

(This includes programs such as a hospital

- based nursing program or radiologic technology program.)

You must include a copy of your current letter of accreditation.

Abbreviation of accrediting agency (A list of abbreviations accompanies this application.)

 What year did your accrediting agency last accredit you?

 For how many years is this accreditation granted?

Check here if this is your primary accreditor

Check here if this is an Institution

- wide Accreditor

Check here if this is a Programmatic Accreditor

Provide the End Date if you are no longer accredited by this agency.

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate sheet, repeat

the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as appropriate for each question.

Insert continuation sheets following the page where the question is asked.

You must show current accreditation or give an explanation in Question 69 ( Section K).

### 9 Section B

16. Check here if you do not offer a flight program, and go to Question 17

.

If you offer a flight program, provide your certification number from the U.S. Federal

Aviation Administration (FAA).

Number

Date FAA certification expires

(mm/dd/yyyy format)



### 17. What state agencies authorize or license you to provide postsecondary educational programs?

(For this question, do not include educational programs that are provi ded at “distance learning” sites.)



### a. Check here if you are a public institution and do not provide at least 50% of

an educational program outside your state, and go to Section C.

b. Check here if you are a public institution and you do provide at least 50% of an

educational program outside your state, and list (for each state other than your

“home” state) each state agency that licenses you, or otherwise provides you with

legal author ity, to provide postsecondary educational programs.

c. Check here if you are a private institution, and list each state agency that licenses



### you, or otherwise provides you with legal aut hority, to provide postsecondary

educational programs.

d. Check here if you or your programs are not required to be authorized or licensed by

a state agency, and include a copy of the basis for that determination

.

A gency Name

Business street address

City

### 10 Section C

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)



### Telephone number (including area code)

ext:

Fax number (including area code)

ext:

E

- mail address (if applicable)

You must include a copy of your current state license(s) or other state authorization(s)

and/or exemption(s).

Provide the End Date if you are no longer authorized by this agency.

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate sheet,

repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as appropriate for

each question. Insert continuation sheets following the page where the question is asked.



# Section C. Please describe your institutional

control and structure.

18. Check your type of institutional structure (check one).

Public institution

Private nonprofit 501(c)(3) institution

You must include a copy of your 501(c)(3) designation from the IRS.

For

- profit institution

### 11 Section C

Foreign institution (check one)

Public institution

Private nonprofit institution

You must include a certified English translation of your

nonprofit de signation status.

For

- profit institution

( Note: Foreign graduate medical schools and foreign veterinary schools whose

students complete their clinical training at an approve d veterinary school in the U.S.

are the only foreign for

- profit institution s eligible to apply to participate in federal

student f inancial aid programs.)

19. Check here if this is a request for initial certification, and go to Question 20

.

For all other institutions, since you were last certified to participate in federal student

financial aid programs, has your institutional structure changed?

Yes No

If yes, give the date of the change.

(mm/dd/yyyy format)

20. Check here if you are a public institution, and go to Section E

.

Check here if you are not a public institution, and list the names of your board of trustees or

your board of directors.

Check here if you have a board of trustees.

Check here if you have a board of directors.

Check here if you have more than 10 on your board, list only the board’s

executive committee

, and provide the name of a contact person in Question 21.

### 12 Section C

First name, MI , Last name , Suffix

(include prefix, such as Mr., Ms., Dr.)

### 13 Section C



### 21 If you provide only the board’s executive committee in Question 20, tell us who is the

appropriate person to contact for further information about your board (for example, the board’s

recording secretary)?

Check here if this is the s ame person as in Question 10.

Check here if this is the s ame person as in Question 12.

If neither of these people, complete the information below.

First name, MI , Last name , Suffix

(include prefix, such as Mr., Ms., Dr.)



### Job T itle

Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)



### Telephone number (including area code)

ext:



### Fax number (including area code)

ext:



### E

- mail address

### 14 Section D



# Section D. If you are a for

- profit institution, or are a not

for

- profit institution with a change in control,

please answer these questions. (This includes

for

- profit foreign graduate medical schools.)

Check here if this does not apply to you and go to Sectio n E

.

22

– 24 Provide information for each person or entity that directly or indirectly owns a 25% or greater interest in

your institution.

a. The owner or person is (check one):

a corporation (complete b. and c. )

Publicly traded

- Provide the stock exchange trading symbol ___________

Closely held corporation

Subchapter S C orporation

Limited Liability Company

Other, identify _________________________

an unincorporated business entity (such as a partnership or trust) (complete b. and c.)

General partner/partnership

Limited liability

Voting trust

Other, identify _________________________

an individual (complete d.)

### 15 Section D

b. Name of corporation or other business entity

Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

Telephone number (including area code)

ext:

Fax number (including area code)

ext:

E

- mail address

Percentage of ownership Date ownership began TIN

Identify the state or countr y in which you are incorporated.

If you are a corporation, give the name and address of the contact person (sometimes known as the

“registered agent”) within the state or foreign country where you are incorporated.

First name, MI, Last name, Suffix

(include prefix, such as Mr., Ms., Dr.)



### Job Title

### 16 Section D

Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)



### Telephone number (including area code)

ext:



### Fax number (including area code)

ext:



### E

- mail address

c

. List the follow ing information for each person, corporation, or unincorporated business

entity that directly or indirectly owns a 25% or greater interest in the corporate owner

or entity 

### :

Name of owner

First name, MI , Last name , Suffix

( include prefix, such as Mr., Ms., Dr.)



### Business street address

City

### 17 Section D

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)



### Telephone number (including area code)

ext:



### Fax number (including area code)

ext:



### E

- mail address

Home address (for person owners)

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

Percentage of ownership Date ownership began SSN or TIN (required)

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate sheet, repeat the

question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as appropriate for each question.

Insert continuation sh eets following the page where the question is asked

.

### 18 Section D

d

. If the owner is an individual, provide the following information.

First name, MI, Last name, Suffix

( include prefix, such as Mr., Ms., Dr.)



### Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)



### Telephone number (including area code)

ext:



### Fax number (including area code)

ext:



### E

- mail address

Home address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

Percentage of ownership Date ownership began SSN of owner (required)

### 19 Section D

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate sheet,

repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as appropriate for each

question. Insert continuation sheets following the page where the question is asked

.

25. Has a person or entity listed in Question 24 or a member of that person's family or a director of your

institution owned 25% or more or held a position listed below of another institution that is now

participating in or ever participated in federal student financial aid programs or of a third

- party servicer

listed in Question 58?

The ownership could be:

• individual, or

• held by one or more family members, or

• in combination with others, such as a voting trust.

The position held at another institution could be any of the following:

• member of the board of directors, or

• chief executive officer, or

• other executive officer, general partner or director of the institution or servicer.

Yes No

If yes, what is the name of the owner (either the name of a person or an entity) or the director?

(If a person, include prefix, such as Mr., Ms., Dr.)

If applicable, what is the name of the third

- party servicer that is or was owned?

If applicable, what is the name of the institution that is or was owned?

If applicable, what is the current or former OPE ID of this institution?

If applicable, when did ownership/position end?

### 20 Section D

Is there any liability currently owed to the Department that was established during the

period of ownership or position held? (If yes, please explain in Section K, Question 69)

Yes No

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate sheet, repeat

the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as appropriate for each question.

Insert continuation sheets following the page where the question is asked.

### 21 Section E



# Section E. Please provide the following information

for each educational program that you

are requesting be eligible to participate in

federal student financial aid programs.

26. Please check each box that describes the educational programs that you provide as of the

date you submit this application or that you will provide during the current award year.

Provide information only on programs that you wish to be eligible for federal student

financial aid.

(You may check more than one box.)

Note: The institution must be able to demonstrate a reasonable relationship between the length of the

program and the entry

- level requirement for the recognized occupation for which the program

prepares the student. The Secretary considers the relationship to be reasonable if the number of

clock hours provided in the program does not exceed by more than 50 percent the min imum

number of clock hours required for training in the recognized occupation for which the program

prepares the student, as established by the State in which the program is offered, if the State has

established such a requirement, or as established by any Federal agency. If the program exceeds by

more than 50 percent of the State or Federal minimum number of clock hours, please explain in

Section K, Question 69.

Note: Post

- baccalaureate students pursuing prerequisite coursework (such as prerequisite c ourses for

medical school) have their eligibility determined on the basis of student eligibility for federal

student financial aid criteria rather than program eligibility criteria. Therefore, these types of

programs are not included here.

a. associate d egree programs

b. bachelor’s degree programs

c. master’s degree programs or doctoral degree programs

d. first professional degree programs

Do you measure student's progress in any of these degree programs by direct assessment instead of credit

or clock hours?

Yes No

e. graduate or professional programs that

 do not lead to a post

- baccalaureate degree

,

 are at least 10 weeks, and

 provide at least 8 semester or trimester credit hours, 12 quarter credit hours,

or 300 clock hours of instruction

.

 prepare students for gainful employ ment in a recognized occupation

### 22 Section E

f. two

- academic

- year transfer programs (see glossary)

g. undergraduate programs that

 lead to a certificate or other recognized educational credential,

 p repare students for gainful employment in a recognized occupation,

 are at least 1 5 weeks, and

 provide at least 16 semester or trimester credit hours, 24 quarter credit hours, or

6 00 clock hours of instruction

.

h. undergraduate programs that

 lead to a certificate or other recognized educational credential,

 p repare students for gainful employment in a recognized occupation,

 are at least 1 0 weeks, and

 provide at least 8 semester or trimester credit hours, 12 quarter credit hours, or

3 00 clock hours of instruction

, AND

 require an enrolling regular student to have an associate degree or higher degree.

i. undergraduate programs that

 lead to a certificate or other recognized educational credential,

 prepare students for gainful employment in a recognized occupation,

 are at least 10 weeks, and

 provide at least 300 but not more than 599 clock hours of instruction,

 do not exceed by more than 50% the minimum number of clock hours established

by the state for such training programs, and

 have been provided for at least one year.

j. Post

- baccalaureate teacher certification progra m necessary to become a teacher

in an elementary o r secondary school in that state. Please refer to the glossary for

more information about this program type.

k. Comprehensive Transition and Postsecondary Program (for students with

intellectual disabilities

- please refer to 34 C .F.R. 668.231 for information about

the requirements of this program)

Check here if you award an associate degree, bachelor’s degree, or higher degree to all

your students who successfully complete any of your programs.

### 23 Section E

27. Based on the boxes checked in Question 26, please provide the following information for the

educational programs that you wish to be eligible for federal student aid.

a. If you checked box a

. in Question 26, provide information about your associate degree

program s

.

Name of program

CIP code (A list of CIP codes accompanies this application.)

Number of W eeks

Clock hours (number of hours) of instruction

Number of credit hours

Type of Hours (check one)



### semester trimester quarter clock

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate

sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as

appropriate for each question. Insert continuat ion sheets following the page where the question is asked.

b. If you checked box b

. in Question 26, provide information about your bachelor’s degree

programs.

Name of program

CIP code (A list of CIP codes accompanies this application.)

Number of Weeks

### 24 Section E

Clock hours (number of hours) of instruction

Number of credit hours

Type of Hours (check one)



### semester trimester quarter clock

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate

sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as

appropriate for each question. Insert continuation sheets following the page where the question is asked.

c. If you checked box c. in Question 26, provide information about your master’s and/or

doctoral degre programs.

Name of program

CIP code (A list of CIP codes accompanies this application.)

Number of Weeks

Clock hours (number of hours) of instruction

Number of credit hours

Type of Hours (check one)



### semester trimester quarter clock

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate

sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as

appropriate for each question. Insert continuation sheets following the page where the question is asked.

### 25 Section E

d. If you checked box d. in Question 26, provide information about your first professional

degree programs.

Name of program

CIP code (A list of CIP codes accompanies this application.)

Number of Weeks

Clock hours (number of hours) of instruction

Number of credit hours

Type of Hours (check one)



### semester trimester quarter clock

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate

sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as

appropriate for each question. Insert continuation sheets following the page where the question is asked.

e. If you checked box e. in Question 26, provide information about your non

- degree graduate

programs.

N ame of program

CIP code (A list of CIP codes accompanies this application.)

Number of Weeks

C lock hours (number of hours) of instruction

### 26 Section E

Number of credit hours

Type of Hours (check one)



### semester trimester quarter clock

Check here if you need space to give more than one answer and continue on a separate sheet. On the

separate sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so

on as appropriate for each question. Insert continuation sheets following the page where the question is

asked.

f. If you checked box f. in Question 26, provide information about your two

- academic

- year

transfer programs.

Name of program

CIP code (A list of CIP codes accompanies this application.)

Number of Weeks

Clock hours (number of hours) of instruction

Number of credit hours

Type of Hours (check one)



### semester trimester quarter clock

Check here if you need space to give more than one answer and continue on a separate sheet. On the

separate sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so

on as appropriate for each question. Insert continuation sheets following the page where the question is

asked.

### 27 Se ction E

g. If you checked box g. or h. in Question 26, provide information about your non

- degree

undergraduate programs.

Name of program

CIP code (A list of CIP codes accompanies this application.)

Number of Weeks

Clock hours (number of hours) of instruction

Number of credit hours

Type of Hours (check one)



### semester trimester quarter clock

Is each course within the program acceptable for full credit toward your associate degree or

higher d egree?

Yes No

Check here if you need space to give more than one answer and continue on a separate sheet. On the

separate sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so

on as appropriate for each question. Insert continuation sh eets following the page where the question is

asked.

h. If you checked box i. in Question 26, provide information about your non

- degree

undergraduate programs.

Name of program

CIP code (A list of CIP codes accompanies this application.)

### 28 Section E

Number of Weeks

Clock hours (number of hours) of instruction



### Maximum number of clock hours authorized by the state licensing agency

Completion rate*

Placement rate*

*Provide the completion rate and the placement rate for your most recently completed award

year. (Instructions on how to calculate the completion rate are found in 34 CFR 668.8(f).

Instructions on how to calculate the placement rate are found in 34 CFR 668.8(g).)

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate

sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as

appropriate for each question. Insert continuation sheets following the page where the questi on is asked.

i. If you checked box k. in Question 26, provide information about your C omprehensive

T ransition and P ostsecondary P rogram.

Name of program

CIP code (A list of CIP codes accompanies this application.)

Number of Weeks

Clock hours (number of hours) of instruction

### 29 Section E

Number of credit hours

Type of Hours (check one)



### semester trimester quarter clock

Is each course within the program acceptable for full credit toward your associate degree or

higher d egree?

Yes No

ADDITIONAL INFORMATION REQUIRED: If not previously provided, the

institution must provide a detailed description of this Comprehensive Transition and

Postsecondary Program addressing all of the components of the program as defined in 34

C.F.R. 668.231. The institution must send this infor mation as a pdf attachment to

FSA_PEPS@ed.gov

.

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate sheet,

repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as appropriate for

each question. Insert continuation sheets following the page where the question is asked.

28

. Do you contract with an organization or ineligible institution to provide more than 25% of any

educational program, (such as internship, externship, practicum in nursing, midwifery, medical

technician, etc.)?



### Note: If you contract more than 50% of the program to an organization

or ineligible institution, the program is not eligible for Title IV.

Yes No



### a. If yes, provide the following information.

Name of program

Name of organization or ineligible institution

Corporation name, if applicable

### 30 Section E

Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)



### Former OPE ID number of the other institution, if applicable

What percent of the program is contracted out?

You must include a copy of the approval from your accrediting agency for contracting

this program.

b. Check here if any owner or person listed in Question 24 or Question 25

directly or indirectly



### • owns or controls 25% or more of the ineligible institution



### or



### • serves as a director or as an executive officer of the ineligible institution.



### What is the name of this owner or person?

c. Did the ineligible institution withdraw from participating in federal student financial aid

programs under a termination, show cause, suspension, or similar type of proceeding

initiated by its state licensing agency, accrediting agency, guarantor, or the U .S. Secretary

of Education?

Yes No

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate sheet,

repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as appropriate for

each question. Insert continuation sheets following the page where the.

### 31 Section F



# Section F. Please tell us about your locations.

29. What is your principal location?

Name of location

Business street address

City County

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

30. Provide the following information for any of your locations (other than your principal location)

t hat meet any one of these three criteria and at which you provide educational programs to students

whom you wish to participate in federal student financial aid programs:

It is a location where students could complete 50% or more of an educational program that

you offer during the current award year.

or

It is a location where students could complete at least 50% of an educational program

over a two

- year period (consisting of the current award year and the most recently

completed award year).

or

It is a location where you provide any educational programs if, during the past two

year period (consisting of the current award year and the most recently completed

award year), you told students that they could complete at least 50% of any

educational programs there.

Name of location

Business street address

City County

### 32 Section F

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

OPE ID number of location or if no OPE ID number, check here

DUNS number (Optional) (If you do not have a DUNS number, you can contact Dun &

Bradstreet

at 1

- 800

- 333

- 0505 to have a number assigned.)

Would you like to receive mailings from the Department at this location?

Yes No

Check here if the mailing address is different from the address above, and

provide the mailing address below.

Mailing address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

Check here if you need space to give more than one answer and continue on a separate sheet. On the

separate sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3,

and so on as appropriate for each question. Insert continuation sheets following the page where the

questi on is asked.

### 33 Section G



# Section G. Please tell us about your correspondence

courses, your students enrolled under

ability

- to

- benefit provisions, and your

incarcerated students.

31. Are any of your programs offered in whole or part by correspondence or distance

education?

Yes No



### 32a. For the most recently completed award year, were more than 50% of your courses

taught by means of correspondence? (See 34 CFR 600.7 and 668.38)

Note: If a course is offered through traditional methods and through correspondence, then that

course should be counted under both traditional methods and correspondence. Therefore, the

same course might be counted more than once.

Yes No



### 32b. For the most recently completed award year, were 50% or more of your regular students

enrolled in correspondence courses? (See 34 CFR 600.7, and 668.38)

Yes No



### 33. For the most recently completed award year, were more than 50% of your regular students

ability

- to

- benefit students? (See 34 CFR 600.7 and 668.32)

Note: Do not include students who are being educated at your institution under a specific

contract with federal, state, or local governments for training purposes (such as most

contracts under the Job Training Partnership Act)

Yes No



### 34. During the most recently completed award year, were more than 25% of your

regular students incarcerated? (See 34 CFR 600.2, 600.7, and 668.32)

Yes No

### 34 Section H



# Section H. Please complete this section if this is an

initial application or you were certified

but you have a change in your ownership

or structure , are seeking reinstatement

,

or you want to add or drop a Title IV

program

.

Check here if this is not an initial application or a change in ownership or

structure or for reinstatement, and go to Section I.

Note: Here “change in ownership or structure” refers to a change in ownership, conversion to or

from a non

- profit institution, or a merger of two or more institutions.



### If you acquired the institution or if the institution is the result of a merger of two

or more former institutions, you will be liable for any debts incurred by your

predecessors under federal student financial aid programs.

35. Tell us why you are completing this section.

This is an initial application Tell us on what date you were both legally authorized

to provide and began continuously providing the education al training program for

which you are seeking eligibility. Then, indicate below whether you are an

institution with or without history.

Month, Day, Year Note: If you are a for

- profit institution or if you offer

only a progam(s) of less than one academic year,

you must have been in existence for at least two

years 

### to be eligible to participate in federal

student financial aid programs

Y ou are an institution without history. A nswer Questions 36, 37, and

38, then go to Section I

.

You are an institution with history (for example, you have been in operation

for one or two years). Answer all the questions in this section.

### 35 Section H

You are an institution with a change in your ownership. Answer Questions 36, 37, and

38, then go to Section I

.

You are an institution that converted to a not

- for

- profit institution. Answer Questions

36, 37, and 38, then go to Section I.

You are an institution that converted to a for

- profit institution. Answer Questions 36,

37, and 38 then go to Section I

.

You a re an institution resulting from a merger in the past four years. Answer Questions

36, 37, and 38 about the newly formed institution, then go to Section I

.

You are an institution seeking reinstatement. Answer all the questions in this section.



### 36. How many full

- time equivalent (FTE) financial aid staff members do you have?

Administrative, counselors, or other professionals

FTE

Clerical

FTE



### 37. Indicate all of the federal student financial aid programs in which you are seeking approval

to participate. ( Note: Foreign institutions, including foreign graduate medical schools, may

apply only for the William D. Ford Federal Direct Loan Program (Direct Loan Program))

Federal Pell Grant Program

Federal Perkins Loan Program

Federal Supplemental Educational Oppo rtunity Grant (FSEOG) Program

Federal Work

- Study (FWS) Program

Federal Work

- Study

- regular or general

Job Location and Development (JLD)

Private

- Sector Employment

### 36 Section H

Federal Family Education Loan (FFEL) Program

- No Longer Available

(formerly called the Guaranteed Student Loan Program)

Indicate specific programs within FFEL for which you are seeking approval to participate.

Federal Stafford Loan Program (subsidized)

Federal Stafford Loan Program (unsubsidized)

Federal PLUS Loan Program (parent loans)

William D. Ford Federal Direct Loan Program (Direct Loan Program)

Indicate specific programs within the Direct Loan Program for which you are seeking approval

to participate.

Federal Direct Loan Program (subsidized)

Federal Direct Loan Program (unsubsidized)

Federal Direct PLUS Loan Program (parent loans)



### 38. Do you anticipate an increase of 10% or more in your student body in the next award year?

Yes No

H ow many regular students do you estimate would be eligible to receive federal student

financial aid for the remainder of the current award year and each of the next two award

years if you become eligible to participate in federal student financial aid programs?

Estimated number for the remainder of the current award year

Estimated number for the next award year

Estimated number for the award year following the next award

year

39. Provide the following information about your regular students. (If a student drops out

and then reenrolls, count the student each time.)

a. How many regular students were enrolled at your institution during your

most recently completed award year?

### 37 Section H

b. How many regular students in a. dropped out during the 100% refund period during

your most recently completed award year?

c. How many regular students in a. dropped out after the 100% refund period during

your most recently completed award year?

40. If you provide vocational programs, list all such educational programs (not classes):

that you have provided continuously for at least 24 months

and

for which you would like regular students to be eligible for federal student

financial aid.

Name of program (name should be consistent with Question 27)

Check here if you need space to give more answers and continue on a separate sheet. On the separate sheet,

repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as

appropriate for each question. Insert continuation sheets following the page where the question is asked.

### 38 Section I



# Section I. If you are a foreign institution, please

complete this section. (This includes

foreign graduate medical schools.)

Check here if you are not a foreign institution, and go to Section J.

Note: If you are a foreign institution, you must include a copy of y our most recent catalog and a

certified 

### English translation ( see glossary ) of all sections dealing with degrees and programs

provided at your institution.

41. Do you admit as regular students only people who have a credential of secondary school

completion or its recognized equivalent?

Yes No



### 42. 

### In the country where you are located, are you legally authorized to provide an

educational program beyond the secondary school level?

Yes No



### I f yes, what is the name and address of the agency or ministry within the country that

enforces this authority?

Name of office

Business street address

City

Foreign Province, Country , Postal Code

Telephone number (Complete international telephone number)

ext:

### 39 Section I

F oreign f ax

ext:

E

- mail addre s s

I nclude a copy of your legal authorization and its certified English translation.

43. Are you legally authorized to award a degree that is equivalent to an associate,

baccalaureate, graduate, or professional degree awarded in the United States?

Yes No



### I nclude a copy of your legal authorization and its certified English translation.

44. Do you provide an educational program that is at least a two

- academic

- year program

acceptable for full credit toward the equivalent of a baccalaureate degree awarded in the

United States?

Yes No



### 45. Do you provide any educational programs that meet all three of these criteria?

• The program is equivalent to at least a one

- academic

- year training

program in the United States.

and

• The program leads to a certificate, degree, or other educational

credential that is equivalent to one offered in the United States.

and

• The program prepares students for gainful employment in an

occupation that is equivalent to one in the United States.

Yes No



### 46. Do you have administrative offices and/or recruiting offices in the United States that represent

you?

Yes No

### 40 Section I

If yes, provide the following information.



### Name of U.S. administrative office

Business street address

City

State and Zip +4

Telephone number (including area code)

ext:



### Fax number (including area code)

ext:

E

- mail address

Name of contact person at the office :

First name, Middle initial, Last name

(include prefix, such as Mr., Ms., Dr. and suffix such as Jr., II)

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate

sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as

appropriate for each question. Insert continuation sheets following the page where the question is asked.

Check here if you are a foreign institution that is not a foreign graduate medical or

veterinary school and go to Section J.

### 41 Section I

47. Where is the facility at which you provide graduate medical educational program instruction in

your country?

Name of facility

Address

City

Foreign Province, Country

, and Postal Code

Telephone number (Complete international telephone number)

ext:

F oreign f ax

ext:

E

- mail address

Name of contact person at the facility:

First name, Middle initial, Last name

(include prefix, such as Mr., Ms., Dr. and suffix such as Jr., II )

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate sheet,

repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as appropriate for

each question. Insert continuation sheets following the page where the question is asked.

### 42 Section I



### 48. What entity in your country is legally autho rized to evaluate the quality of your medical

educational program?

Name of entity

Address

City

Foreign Province, Country

, and Postal Code



### Telephone number (Complete international telephone number)

ext:

F oreign f ax

ext:

E

- mail address

Name of contact person at the entity:

First name, Middle initial, Last name

(include prefix, such as Mr., Ms., Dr. and suffix such as Jr., II )

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate sheet,

repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as appropriate for

each question. Insert continuation sheets following the page where the question is asked.

### 43 Section I

49. Are you approved by the entity listed in Question 48 to provide a graduate medical

educational program in your country?

Yes No



### I nclude a copy of each approva l and its certified English translation.

50. What is the length of the program of graduate clinical and medical instruction?

months

51. Is any part of your program of graduate clinical instruction provided in the United States?

Yes No



### If yes, provide the following information.

a. Name of facility

Business street address

City

State and zip+4



### Telephone number (including area code)

ext:

Fax number (including area code)

ext:

E

- mail address

### 44 Section I

Name of contact person at the facility:

First name, Middle initial, Last name

(include prefix, such as Mr., Ms., Dr. and suffix such as Jr., II )

b. Part of program offered:

Classroom Clinical

Do you provide the remainder of your program of graduate medical instruction in your country?

Yes No

c. What medical licensing boards and evaluating bodies in the United States currently approved

the clinical training in the United States?

d. W as your clinical training program in the United States approved as of January 1, 1992 by

the state in which you offer it?

Yes No

I nclude a copy of the approval.

If yes, is it currently approved by the state?

Yes No

I nclude a copy of the approval.

Check here if you need space to give more than one answer and continue on a separate sheet. On the

separate sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and

so on as appropriate for each question. Insert continuation sheets following the page where the question is

asked.

### 45 Section I

52. Li st the dates of graduation and the number of regular students who graduated within the past three

12

- month periods.

Dates Dates Dates

Graduates Graduates Graduates

Check here if you need space to give more than one answer and continue on a separate sheet. On the

separate sheet, repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on

as appropriate for each question. Insert continuation sheets following the page where the question is asked.

53. What are the beginning and ending dates of your institution’s most recently completed academic

year?

Beginning date

Ending date



### 54. How many full

- time regular students were enrolled during the most recently completed academic

year?

55. How many of the regular students in Question 54 were not U.S. Citizens or residents eligible for

U.S. federal financial aid programs?



### 56. If your school is located in Canada, go to Section J. During the most recently completed year,

how many of your regular students and graduates from the three preceding years took any

"step" of the examinations administered by the Education Commission for Foreign Medical

Graduates?

How many of these students received passing scores on any “step” o f the examinations?

### 46 Section I

57. Check here if you are a foreign institution that is not a foreign veterinary school, and go to

Section J.

Is any part of your program of Veterinary instruction provided in the United States?

Yes No

Name of facility



### Business street address

City

State and Zip +4

Telephone number (including area code)

ext:

Fax number (including area code)

ext:

E

- mail address

### 47 Section J



# Section J. Please tell us abou t your third

- party

servicers. ( This includes your Ability to

Benefit Test.)

58 a. If you contract with any third

- party servicer to perform any function relating to federal 

### student

financial aid programs, or use an ability to benefit test for students who d o not have a high

school diploma or its recognized equivalent, provide the following information about each

servicer and/or tester.

Note: Do not list independent auditors. Also do not list vendors that provide books, forms, or

computer programs (in other words, do not list vendors unless they actually perform services

or functions for which you are responsible under the HEA programs).

Name of servicer’s contact person

First name, Middle initial, Last name

( include prefix, such as Mr., Ms., Dr.)

Job T itle

Company name

(Please enter the company name. If there is no company name, enter the tester’s name.)

Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

Telephone number (including area code)

ext:

Fax number (including area code)



### ext:

### 48 Section J

E

- mail address



### Indicate the service provided:

Performing needs analysis

Authorizing financial aid

Disbursing financial aid

Performing loan servicing

Counseling/providing information for students

Performing loan collection

Preparing/maintaining student aid transcripts (Transfer student monitoring requirement)

Ability to Benefit Tester

O ther (specify)

Check here if you need space to give more than one answer and continue on a separate sheet. On the separate sheet,

repeat the question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as appropriate for

each question. Insert continuation sheets following the page wh ere the question is asked.



### 58b. Identify which ability to benefit test you use.

### 49 Section K



# Section K. Please assure us of your administrative

capability and your financial responsibility.

Note: To expand on any of your answers or explain why the question was not answered , use Question 69.

.

59. Do you have a system of internal checks and balances for administ ering federal student financial

aid that meets federal regulations? (See 34 CFR 668.16.)

Yes

60. Do you divide the functions of determining student awards and disbursing funds that result from

those award decisions? (See 34 CFR 668.16.)

Yes

61. Do you have procedures that ensure frequent, periodic reconciliation of fiscal office and financial

aid office award data? (See 34 CFR 668.14, 668.16, 668.24, 674.19, 675.19, 676.19, and 690.81.)

Yes

62. Do you have a system to identify and resolve discrepancies in information you receive from

various sources about a student’s application for financial aid? (See 34 CFR 668.16.)

Yes

63. Do you have a policy that meets federal regulations for requiring sa tisfactory academic progress

for recipients of federal student financial aid? (See 34 CFR 668.16 and 668.34.)

Yes

64. Do you have procedures that ensure that your requests for federal cash do not exceed the amount of

funds you need immediately to make aid disbursements to students? (See 34 CFR 668.163.)

Yes

65. Do you have a policy that meets federal regulations for return ing Title IV funds when a student

withdraws from classes? (See 34 CFR 668.22.)

Yes

### 50 Section K

66a. Have you submitted your required annual financial statement audits to us on time? (For

initial applicants, have you established a process to ensure that you submit your required

annual financial statement audit to us on time?) (See 34 CFR 668.23.)



### Yes

66b

. Have you submitted your required annual federal student financial aid compliance audits to us on time?

(For initial applicants, have y ou established a process to ensure that you submit your required annual

federal student financial aid compliance audit to us on time?) (See 34 CFR 668.23.)



### Yes

67. Do you use the electronic processes required by the Secretary? (See 34 CF668.16)



### Yes

68. Do you have a process to insure you obtain the necessary approvals from the Department for expanding or

re

- establishing your institutional eligibility, (such as changes of ownership resulting in a change of control,

excluded changes in ownership, o r adding new locations in certain circumstances), and that you notify us

within 10 days about other important changes (such as changing your name, address or official)? (See 34

CFR 600.10, 600.20 and 600.21)



### Yes

69. (Optional) Use this area if you need extra space to tell us about any unusual circumstances or to

provide additional explanations about your application.

Check here if you need additional space and continue on a separate sheet. On the separate sheet, repeat the

question being answered, numbering each sheet as page 1 of 3, page 2 of 3, and so on as appropriate for each

question. Insert continuation sheets following the page where the question is asked.

### 51 Section K

70 a. (Optional) Provide the following information for any person or firm outside your institution that you

wish to designate as your agent to represent you in matters related to this application.

First name, Middle initial, Last name

(include prefix, s uch as Mr., Ms., Dr.)

Job Title

Company name

Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

Telephone number (including area code)

ext:

Fax number (including area code)

ext:

E

- mail address

70 b. Provide the following information for your institution's destination point administrator (DPA)

. First name,

Middle initial, Last name

(include prefix, such as Mr., Ms., Dr.)

Job Title

Company Name

### 52 Section K

Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

Telephone number (including area code)

ext:

Fax number (including area code)

ext:

E

- mail address



### 71. Reporting of Foreign Gifts, Contracts and Relationships.

Note: All domestic institutions that receive any Federal financial assistance (directly or indirectly) and

offer a bachelor's degree or higher or that offer a transfer program of not less than two years that is

acceptable for credit toward a bachelor's degree are required to report foreign gifts, contracts, or ownership

and control. This information must be reported to the Secretary no later than January 31 or July 31,

immediately following receipt of gifts from a foreign source, contract with a foreign entity, and any

ownership interest in or control over the institution by a foreign entity that exceeds $250,000 in any

calendar year. ( Please p rovide a description of any conditions or restrictions associated with the foreign

gift in Question 69. )

Gift Type

Date received

(mm/dd/yyyy format)

Amount

### 53 Section K

Giver Name

Country

Contract Start Date

(mm/dd/yyyy format)

Contract End Date

(mm/dd/yyyy format)

### 54 Section L



# Section L. Please have the appropriate person in

authority review, sign, and date this d ocument.

I hereby certify that, to the best of my knowledge and belief, all information in this document is true and

correct. I understand that if my institution provides false or misleading information, (a) the U.S. Department

of Education may deny the institution’s request for eligibility to participate in federal student financial aid

programs and/or revoke eligibility once it has been granted and (b) the instit ution may be liable for all federal

student financial aid funds it or its students received. I also understand that I may be subject to a fine of not

more than $25,000 or imprisonment of not more than five years, or both, for misinformation that is materia l to

receipt and stewardship of federal student financial aid funds.

Signature of President/CEO/Chancellor

Date

Name of institution

Name of President/CEO/Chancellor

Check here if this is the same person as in Question 10. If not, complete the information below.

JobT itle

Business street address

City

State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.)

Telephone number (including area code)

ext:

Fax number (including area code)

ext:

E

- mail address

### 55 Section M



# Section M. Please include copies of appropriate

documents as part of your application.

Indicate all copies of documents you are including with this application.

Current letter of accreditation and any attachments. (See Question 15)

(Please Note: The accreditation certificate is not sufficient documentation)



### Valid state license or other state authorization (See Question 17)

For private nonprofit institutions

- 501(c)(3) designation from the IRS (See Qu estion 18)

If your institution contracts with an organization or ineligible institution to provide more than 25%

of any educational program

- a copy of the approval from your accrediting agency for contracting

this program (See Question 28)

For initial applicants (See Question 35)

Audited financial statements for the (two) most recently completed fiscal year(s)

Default management plan: Either

The default management plan recommended by the Secretary of

Education. (check this box, do not include the plan); or

A default management plan other than the plan recommended by the Secretary of

Education. (check this box, do not include the plan); or

The institution is exempt under 487(a)(14)(C) of the HEA fro m

providing a default management plan.

For institutions with a change in ownership or structure (See Question 35)

Audited financial statements of the institution's two most recently completed fiscal years that are

prepared in accordance with Generally Accepted Accounting Principles (GAAP) and audited in

accordance with Generally Accepted Government Auditing Standards (GAGAS); and



### Audited financial statements of the institution's new owner's two most recently completed fiscal years

that are prepared in accordance with Generally Accepted Accounting Principles (GAAP) and audited

in accordance with Generally Accepted Gov ernment Auditing Standards (GAGAS) or equivalent

information for that owner that is acceptable to the Secretary.

Same

- day balance sheet, audited in accordance with GAGAS, showing the financial condition

of the institution after the change in ownership.

### 56 Section M



### Default management plan: Either

The default management plan recommended by the Secretary of

Education. (check this box, do not include the plan); or

A default management plan other than the plan recommeded by the Secretary of

Education. (enclose a copy of the plan); or

The institution is exempt under 487(a)(14)(C) of the HEA from prov iding a

default management plan.

For institutions seeking reinstatement (See Question 35)

Audited financial statements for the two most rece ntly completed fiscal years that are prepared

in accordance with Generally Accepted Accounting Principles (GAAP) and audited in

accordance with Generally Accepted Government Auditing Standards (GAGAS).

Default management plan: Either

The default management plan recommended by the Secretary of

Education. (check this box, do not include the plan); or

A default management plan other than recommended by the Secretary of

Education. (enclose a copy of the plan); or

The institution is exempt under 487(a)(14)(C) of the HEA from providing

a default management plan.

For foreign institutions, including foreign graduate medical schools

For private nonprofit institutions

- a certified English translation of nonprofit designation status

(See Question 18)

Most recent catalog and its certified English translation of all sections dealing with

degrees and programs provided at your institution (See Section I)

Legal authorization and its certified English translation to provide an educational program

beyond the secondary school level in the country where you are located (See Question 42)

Legal authorization and its certified English translation to award a degree that is equivalent to

a degree awarded in the United States (See Question 43)

### 57 Section M



### Legal authorization and its certified English translation to provide graduate medical

,

education (See Question 49)

In addition, if a foreign institution is an initial applicant

Audited financial statements for the two most recent years

Default manag ement plan: Either

The default management plan recommended by the Secretary of Education. (check this

box, do not include the plan); or

A default management plan other than the plan recommended by the Secretary of

Education. (enclose a copy of the plan); or

The institution is exempt under 487(a)(14)(C) of the HEA from providing

a default management plan.

For institutions applying for Comprehensive Transition and Postsecondary Programs (See Question 26k)

A detailed description of your comprehensive transition and postsecondary program addressing all

of the components of the program as defined in 34 C.F.R 668.231

A copy of your institution's Satisfactory Academic Progress policy for the comprehensive

transi tion and postsecondary program

A copy of the notification to your primary accreditor that your institution is providing a

comprehensive transition and postsecondary program