DUE July 1, 2016
One-time fee of $500.00 must be attached. / No fee required for Update Report.
Institution’s first-time exemption date:
Name of Institution:
Principal Location of Institution in New Mexico/Principal Location Out of State (if no physical presence in NM)
Address:
City: / State: / Zip:
Chief Executive Officer: / Phone:
Email: / Fax:
Primary Contact
(Name, Title): / Phone:
Email: / Fax:
Website
Mailing Address if different from physical address above
Address:
City: / State: / Zip:
Ownership(check boxes that apply)
Sole Proprietorship or Partnership. Please attach a list showing the name, business address, and telephone number of each owner.
Corporation Please attach evidence of incorporation. Please also attach a list showing the name, business address, and telephone number of the corporation and the names and addresses of all the corporate officers and of any shareholders who own 20% or more of the corporation.
Non-profit Please attach evidence of non-profit status.
For-profit
For Annual Update Report Only:Please indicate anyinstitutional and program changesas applicable below. If changes have occurred, provide supporting documentation as outlined in 5.100.2 NMAC.
Ownership / YES / NO
Administration / YES / NO
Accreditation / YES / NO
Course Offerings / YES / NO
Does Your Institution Maintain a “Presence” in New Mexico?
“Presence” in New Mexico is defined by rule as “offering courses, programs or degrees on site or from a geographical site in New Mexico or maintaining an administrative, corporate or other address in the state.” 5.100.2.7(L) NMAC.
Therefore, private online out-of-state institutions requiring an internship/externship component to a program have a “presence” in NM.
YES / NO
If your response is “yes,” please indicate what your physical presence is:.
If your response is “no,”please indicate whether you have recruiters coming into New Mexico:.
Accreditation Information: Is the institution accredited by an agency recognized by the U.S. Department of Education?
YES NO / If YES, check one: Regionally AccreditedNationally Accredited
If yes, please provide the following information (use Agency II and III if more than one accrediting agency):
Accrediting Agency I
Address:
City: / State: / Zip:
Contact Name:
Title: / Accreditation Expiration:
Telephone: / Fax:
E-mail: / Website:
Accrediting Agency II
Address:
City: / State: / Zip:
Contact Name:
Title: / Accreditation Expiration:
Telephone: / Fax:
E-mail: / Website:
Accrediting Agency III
Address:
City: / State: / Zip:
Contact Name:
Title: / Accreditation Expiration:
Telephone: / Fax:
E-mail: / Website:
In-State or Out-of-State Exemption Provisions
In accordance with New Mexico Higher Education Department Statute 21-23-1 to -5 NMSA 1978,as amended, a school may claim exemption from licensure under any of the provisions listed below. Check the most appropriate exemption that applies to your institution. For any “yes” response, please provide appropriate documentation.
CHECK ONE: IN-STATE (with a physical presence) OR OUT-OF-STATE (with NO physical presence)
For any questions about this form, please e-mail questions or callat (505) 476-8442.
A post-secondary educational institution that is established by name as an educational institution by the state through a charter, constitutional provision or other action and is supported in whole or in part by state or local taxation. / Yes / No
An occupational, trade, or professional school operating pursuant to any New Mexico Occupational licensing law under the jurisdiction of the New Mexico Regulation & Licensing Department / Yes / No
A course of institution provided by an employer for its employees for training purposes. / Yes / No
Institutions that exclusively offereducation that is solely avocational or recreational in nature. / Yes / No
A course of instruction or study sponsored by a recognized fraternal, trade, business, or professional organization or labor union for the instruction of its members. / Yes / No
Chartered, nonprofit religious institutions whose sole purpose is to train students in religious disciplines to prepare them to assume a vocational objective relating primarily to religion.
If “yes”, attach a copy of your 501(c)3 status letter from the IRS. / Yes / No
An institution funded in full or in part by an Indian tribe or pueblo in the state of New Mexico. / Yes / No
An organization providing only brief courses of instruction designed to teach specific skills that may be applicable in a work setting but are not sufficient in themselves to be considered programs of training in employment. Normally, such instruction shall meet at least three criteria:
1)No more than 40 hours of direct instruction.
2)Tuition/fee for each course does not exceed $500.
3)The student normally enrolls for only one course rather than a sequence of courses. / Yes / No
.
Enrollment Numbers / New Mexico Student Data
Gender / Number of Males
Number of Females
Number of No Responses
Total
Age of Students Enrolled
Total should be equal the Enrollment Total on page 6. / Number of students under 17 years of age
Number of students 18 to 24 years of age
Number of students25 to 34 years of age
Number of students 35 to 44 years of age
Number of students 45 to 64 years of age
Number of students over 65 years of age
Number of No Responses
Total
Ethnicity / Number of Hispanic or Latino
Number of Non-Hispanic or Latino
Number of No Responses
Race / Number of Caucasian/White
Number of American Indian
Number of Black
Number of Asian
Number of Native Hawaiian or Pacific
Number of Two or more ethnicities or races
Number of No Responses
Enrollment Numbers / New Mexico Student Data
Headcount
Full time equals 24 or more semester credit hours in an academic year or the equivalent in quarter credit hours.
Part time equals less than 24 semester credit hours in an academic year or the equivalent.
Other Definitions
Student Dropwill remove the class(es) from the student’s schedule with no record of the student’s enrollment in the class(es) on the official transcript.
Student Withdrawalwill remove the class(es) from the student’s schedule and will result in a grade of ‘W’ on the official transcript for each class withdrawn.
College transfer is the movement of students from the reporting postsecondary institution to another postsecondary institution by which academic credits are accepted or not accepted by a receiving institution.
New Mexico Student Datadefines New Mexico resident students only. / Number of Students enrolled in continuing education courses:
a) Headcount FULL TIME on campus students:
b) Headcount of PART TIMEon campus students:
c) Headcount of FULL TIME off campus students including students enrolled online:
Report how many FULL TIMEoff campus students are studying solely online and are included in the c) total: / (within NM/Outside NM)
d) Headcount of PART TIME off campus students including students enrolled online:
Report how many PART TIME off campus students are studying solely onlineand are included d) total are: / (within NM/Outside NM)
e) Hybrid (a combination of online study combined with any of the other categories listed above):
f) Total headcount of all students: (a+b+c+d+e=f)
Student Drops:
Student Withdrawals:
Student Transfers:
g) Total of all drops, withdrawals & transfers:
h) Total Enrollment (f - g = h):
First Time Student Enrollment / Number of students enrollment as first time student within 16 months of receiving a regular high school diploma:
Is your institution verifying legitimate High School Diplomas? / Yes
No
If yes, please attach Institution’s Policy/Procedure on method used to verify legitimate High School Diploma.
Area of Study with CIP Codes / Completion / Employment Numbers
Please provide information on programs on page 8, based on the following example.
Example:
Area of Study with CIP Codes, Completion & Employment NumbersType of Credential
(Click to select) / CIP Code/
Certificate or Degree Clusters If unknown, see reference below * / Name of Program / Program location:
On campus
Off Campus
On line
Hybrid
(Click to select the ) / Length of Program / Type of Credit Hours
(Click to select the ) / Total Program Cost / Number of Graduates or Completers in the most recent academic year / Number of Graduates or Completers in the most recent academic year
Associate Degree / 51.3301 / Acupuncture, & Oriental Medicine / Hybrid / 60 credit hours / Semester hours / $37,900.00 / 58 / 36
Certificate / 51.0601 / Dental Assistant / On Campus / 35 / Clock hours / $1,400.00 / 43 / 21
Bachelors / 50.0913 / Music Technology / Off Campus / 180 credit hours / Quarter hours / $74,000.00 / 38 / 19
*Every Program must list a CIP code.
Reference: To learn more about the classification of Instructional programs (CIP) and how to determine the CIP Code for any offered program please click on the following link: IPEDS CIP INFORMATION (
If no CIP code relates to the offered program and assistance is needed, contact Diane Vigil-Hayes via email at:
**Please list, under each category, the number of students that completed in each area (Please indicate “N/A if not applicable to your institution). Please use the academic year of summer & fall of 2015 and spring of 2016 to answer this section. If you do not use an academic year, please indicate how you calculated the data.
Area of Study with CIP Codes / Completion / Employment Numbers(Copy this page if program listing requires additional pages)
Type of Credential
(Click to select) / CIP Code/
Certificate or Degree Clusters If unknown, see reference below * / Name of Program / Program location:
On campus
Off Campus
On line
Hybrid
(Click to select) / Length of Program / Type of Credit Hours
(Click to select) / Total Pgrm Cost / Number of Students enrolled / Number of Graduates or Completers in the most recent academic year / Number of Graduates or Completers placed in employment appropriate for completed studies
Within NM * / Outside
NM**
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Financial Aid
- Is Federal Financial Aid available to students enrolled in this school?
- If yes, do you report information to IPEDS?
- If yes, please include the institutions IPEDS unit I.D. number here.
- If yes, Student Default Rate (in percentage)
- Are alternative loans available? (private or bank loans, payment plans, etc.)
- If yes, how many students are relying on alternative loan?
- What is the average loan amount per student?
- If you are subject to federal financial aid, attach hard copies of and web links to the following:
Included - gainful employment disclosure:,
Included - complaint policy with reference to the NMHED for NM students: ,
Included - student catalog:
Certification
As an authorized representative of the educational institution, I hereby certify that the information provided herein, is correct and is an accurate representation of the institution’s operation. In accepting an exempt status, I certify that the institution and its representatives agree to make no reference to the New Mexico Higher Education Department (NMHED) in advertising and/or printed materials. I certify that the institution agrees to notify NMHED of any changes in operation that may influence the exempt status (as noted on page 4). I further certify that the institution agrees to provide to the NMHED an Annual Update Report witheducational information, i.e., brochures, catalogs, etc., on the programs offered by the institution or as requested by the NMHED. I understand that if granted, the exemption will continue until such time the NMHED determines that the exemption no longer applies. I hereby commit the institution to abide by the conditions outlined.
Typed Name and Title
Signature of Chief Administrator / Date
$500.00 for initial exemption claim fee.
No fee if you are submitting an annual update report.
A complete set of pertinent attachments must accompany this form.
PLEASE RETURN AN ORIGINAL OF THIS FORM BY JULY 1, 2016.
New Mexico Higher Education Department, Private Postsecondary Schools Division
2044 Galisteo Street, Suite 4, Santa Fe, NM 87505-2100
For any questions you may have please or call (505) 476-8442.
Each applicant will receive a written determination notification from the Department.
Institution’s Name:
EnrollmentHead CountGenderMedian AgeEthnicity
Study AreaNumber of GraduatesNames of Programs CIP CodesEmployed Graduates
Exemption ApprovedCertificationCatalog
Annual Update Complete Date Exemption Letter was mailed______
Date / SignatureNotes:
3/2016/rlm
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