Private Postsecondary School Division

PRIVATE POSTSECONDARY EDUCATIONAL INSTITUTIONS

INITIAL PROVISIONAL APPROVAL TO OPERATE (PAO) APPLICATION

Due: August 1, 2015

SECTION I:

CERTIFICATION

As an authorized representative of the applicant institution, I hereby certify that the information provided in this application is accurate and complete. I agree that the Department of Higher Education, Private Postsecondary Schools Division or its representatives may conduct inspection visits at any or all instructional sites of the institution to gather additional information pertinent to their evaluation of eligibility for licensure.

I certify that this institution has not filed bankruptcy during the past five years nor has it been under the control of, nor is it managed by a person who has filed bankruptcy associated with the operation of an educational institution during the past five years.

I certify that no owner or manager of the institution has been convicted of or pled no contest or guilty to a crime involving abuse of public funds nor has any owner or manager of this institution controlled or managed an institution that has ceased operation during the past five years without providing for the completion of programs by its students.

I certify that at such time as the management of the institution believes that it may be necessary to close the institution, the Department will be so informed. I understand that such notification must be provided no less than thirty calendar days prior to closure. I further certify that the institution will provide the Department with a plan that provides for (a) completion of programs by all currently active students, (b) preservation of student records, and (c) identification of a responsible agent for the school following closure, consistent to the requirements set forth in 5 NMAC 100.2.

I hereby certify that I have read in its entirety 5 NMAC 100.2 of the New Mexico Higher Education Department and I hereby commit the institution to abide by the conditions for licensure as a private postsecondary institution in New Mexico, consistent with applicable state law and 5 NMAC 100.2

Authorized Representative SignatureDate

,

Print Name, Title

Institution

SECTION II:

EDUCATIONAL INSTITUTION INFORMATION

Date of Application:

Name of Institution:

Address of New Mexico Instructional site:(Street, city, state, zip)

Mailing Address of Institution:(Street, city, state, zip)

Institution’s Phone Number: Fax Number:

E-mail: Web site:

Local authorized representativeTitle:

Email address:

Tele Number Fax Number

Regional/Corporate contact person Title:

Email address:

Tele Number Fax Number

Method of Operation: Residence Distance Learning Combination

Is the institution a branch of another institution? (Y/N) If yes:

The applicant institution is a branch of:

Address of parent institution (street, city, state, zip)

Indicate the levels of education to be offered: CertificateDiploma

Degrees: AA/AS BA/BSMA/MSPhD/EdD

Other:

IPED Reporting? Yes / NoIf yes, IPED #

Name of Institution:

SECTION III:

APPLICATION CHECK LIST

Please initial the appropriate box and attach appropriate documentation. Each document should include the corresponding code in the upper right hand corner.

Institution Ownership: Pursuant to 5.100.2.12 NMAC

Code Initial

(A-1) / Sole Proprietorship/Partnership / If yes, provide a list and resume.
(A-2) / Corporation: For Profit / If yes, provide NM Secretary of State Corporation Commission Registration information:
(A-3) / Corporation: Non Profit / If yes, provide evidence of non-profit status.
(A-4) / NM Taxation’s Revenue Department registration / If yes, provide NM GRT#:
(A-5) / Other / Attach explanation.

Institution Administration: Pursuant to 5.100.2.12 NMAC

(A-6) / Please attach a summary list and resumes for the institution’s management, including the chief executive officer, senior business or finance officer, senior financial aid administrator (if relevant) and senior academic officer.

Accreditation/Other Approvals: Pursuant to 5.100.2.10 NMAC

(A-7) / YES / Please list agencies and provide the most recent notice of your primary institutional accreditation, including the most recent summary findings by the accrediting agency regarding your institution.
NO

Approvals From Other States

(A-8) / YES / Please provide a list of states from which the institution holds approval(s).
NO

Financial Stability: Pursuant to 5.100.2.13 NMAC

(A-9) / Please attach appropriate documentation.

InsuranceCoverage: Pursuant to 5.100.2.13.G NMAC

(A-10) / Please attach appropriate documentation for liability, workers compensation, property and internship site liability coverages.

Fire Department Inspection Report: Pursuant to 5.100.2.13.G NMAC

(A-11) / Please attach appropriate documentation.

Evidence of Surety Bond: Pursuant to 5.100.2.32 NMAC

(A-12) / Please provide evidence of a Surety Bond (not less than $5,000 and not to exceed 20% of anticipated or actual gross annual tuition.) If the institution is part of a corporation the bond should include both the name of the school and the corporation.

Name of Institution:

Advisory Council: Pursuant to 5.100.2.15 NMAC

Code Initial

(A-13) / Please provide a list of the institution’s advisory committee members which include their addresses and telephone numbers.

Enrollment Agreement/Student Transcript: Pursuant to 5.100.2.22 NMAC

(A-14) / Please attach copies of both the enrollment agreement and student transcript.
(A-15) / COOLING OFF POLICY- pertains to student signing an enrollment agreement and/or making initial deposit and entitled to a cooling off period of at least three work days from the date to withdraw and all payments shall be refunded. Pursuant to 5.100.2.20 NMAC

Evaluation/Appraisal: Pursuant to 5.100.2.26 NMAC

(A-16) / Please provide your institution’s plan for assessing the satisfaction of your graduates.
(A-17) / Please provide your institution’s plan for ensuring that courses are current.
(A-18) / Please provide your institution’s plan for faculty improvement in terms of content knowledge and relevant instructional techniques.
(A-19) / Please provide your institution’s plan for using new and appropriate technologies to support instruction.

Catalog: Pursuant to 5.100.2.17 and 5.100.2.21 NMAC

(A-20) / Please provide a copy of your institution’s most recent catalog(s) and additional publications that are routinely provided to students describing the institution and its programs and policies. If you are not yet operating and have not published a catalog, please provide a draft. At a minimum, such material must address in detail:
(A-21) / TUITION POLICY - the tuition and fees charged for each program. Please publish formula found and pursuant to 5.100.2.20 NMAC
(A-22) / REFUND POLICY - the tuition refund policy(ies) of your institution.
Pursuant to 5.100.2.23 NMAC
(A-23) / Your institution’s policy regarding satisfactory academic progress of students, including any time limits imposed for the completion of programs.
Pursuant to 5.100.2.23 NMAC
(A-24) / COMPLAINT POLICY - your institution’s policy regarding handling of complaints from students or other persons. Please add contact information NMHED/PPSD, 2044 Galisteo St, Suite 4, Santa Fe, NM 87505-2100, 505-476-8442 or 505-476-8416 and the following link for forms:
Pursuant to 5.100.2.25 NMAC
(A-25) / COOLING OFF POLICY- pertains to student signing an enrollment agreement and/or making initial deposit and entitled to a cooling off period of at least three work days from the date to withdraw and all payments shall be refunded.
Pursuant to 5.100.2.20 NMAC
(A-26) / ADMISSIONS POLICY - Please provide a clear and detailed statement of describing your procedure for assessing the qualifications of applicants for admission to your institution. Student is required to provide proof of high school diploma or high school equivalency.
Pursuant to 5.100.2.19 NMAC

Name of Institution:

Faculty Qualifications: Pursuant to 5.100.2.14 NMAC

(A-27) / Please provide a brief description of the process you use to select, employ, and retain teaching faculty. Please also provide appropriate sampling of faculty resumes.

Application Fees: Pursuant to 5.100.2.31 NMAC

Code Initial

(A-28) / $4,000.00 Non-refundable / Establishing a new degree-granting institution. Moving an existing institution or establishing a branch campus.
(A-29) / $1000.00 Non-refundable / Establishing a new career school.

SECTION IV:

PROGRAMS

Educational Programs Offered by the Institution: Pursuant to 5.100.2.27 NMAC

Up to SIX(6) ARE PERMITTED PURSUANT TO 5.100.2.16.C NMAC with initial licensure

(A-30) / Please use the Demographic Data Form to provide a list of the following information for each program to be offered by your institution in New Mexico: Type of credential, Federal CIP Code, Name of program, Location, Length of Program, Credit Hour, Program Cost, # of students enrolled, # of graduates, and employment of graduates anticipated during each of the next three years.Include internship agreement and liability insurance for internship site.

#

/

CIP Code

/

Program

/

Degree

/

Check if Internship Required

1

2

3

4

5

6

Name of Institution:

(A-31) / If you currently offer the programs in New Mexico or in another state(s), please also provide proof of any special accreditation currently granted to the program; total enrollment (headcount) in the program during the prior year (new plus continuing students); and student completion rates(s) for the program during the prior three years (or comparable evidence of program success). Please complete demographic data report.
The link is

Bachelor’s and Graduate Degree Programs

(A-32) / If your institution offers bachelor’s and/or graduate degree programs, please provide the following information: a detailed description of the policy and procedure followed in awarding credit for life experience or experience gained through employment related to the program of study, if you award such credit;
(A-33) / A description of the process followed to achieve periodic review and approval of programs by teaching faculty of the institution;
(A-34) / Any agreements that you have signed with accredited institutions to facilitate transfer of credit between institutions;
(A-35) / Samples of course outlines and syllabi; and
(A-36) / Copies of all degree programs/requirements;
(A-37) / If your institution is non-traditional, including use of distance learning, please provide a description of the instructional technique to be employed.
(A-38) / Please attach your plan for meeting the accreditation requirement.

New Mexico Higher Education Department

Private Postsecondary Schools Division

NOTE NEW ADDRESS: 2044 Galisteo Street, Suite 4, Santa Fe, NM 87505-2100

Tele: 505-476-8442 OR 476-8416/Fax: 505-476-8454/Email:

Web:

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Rev. 4/2015