Form CSC-004 "Facility and Equipment Inspection Request" - Texas

Form CSC-004 or the "Facility And Equipment Inspection Request" is a form issued by the Texas Workforce Commission.

Download a PDF version of the Form CSC-004 down below or find it on the Texas Workforce Commission Forms website.

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Download Form CSC-004 "Facility and Equipment Inspection Request" - Texas

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Facility and Equipment Inspection Request
Texas Workforce Commission – Career Schools and Colleges
THIS FORM MUST ACCOMPANY your application for original certificate of approval, change of
address, additional classroom facility, and additional equipment/facilities for a new program.
Date facilities and equipment will be ready for inspection by TWC consultant:
(mm/dd/yyyy)
Submit this form with the following documents:
Floor Plan
Equipment Inventory List
Although we will schedule a survey visit as soon as possible after the "ready for inspection" date you provide,
there may be a delay of 30 days or more, depending upon your location.
Name of School:
Physical Address:
Street
City
State
Zip Code
Person to Contact/Phone Number:
All items below need to be available at your ORIGINAL site visit:
1.
Certificate of Occupancy for current address or letter of release from municipality.
2.
Current fire inspection by municipal authority, or letter of release and approval of private contractor
from municipal authority (last inspection date).
3.
Rental or lease agreement for school facilities, or statement of ownership for current address.
4.
Rental or lease agreement for instructional equipment and instructional aids or statement of ownership.
5.
Floor plan and school facilities are adequate for student capacity, and include: room numbers, pupil
capacities, break room, utilities, uses of rooms, room dimensions, restrooms, and record storage.
6.
Inventory of equipment & instructional aids adequate for student capacity and course objective.
7.
Current list of textbooks, software, and reference library, including: title(s), author/publisher, and
copyright dates.
8.
Sample of each certificate and/or diploma awarded to students.
9.
Narrative description of the school's way of taking and maintaining a positive record of attendance,
including when taken, symbols, methodology, and provisions for permanent maintenance; or evidence
of TWC approval of alternative method of accurately determining a student's last date of attendance for
refund purposes and accurate monitoring of absences.
10.
Sample of forms used to record attendance; and progress, grades and transcript forms (progress, grades
and transcript forms not required for seminar schools).
11.
Statement outlining the methods of payment available to students including, if applicable, terms of
agreements with lending institution(s), charges and true annual percentage rate(s), and the institution
name(s) and address(es).
12.
Examples of all advertising (yellow page, newspaper ad, brochures, audio/video scripts, etc.).
_____________________________________________________________________________________________
Completed forms, inquiries, or corrections to the individual information contained in this form shall be sent to the
TWC Career Schools and Colleges, 101 East 15th Street, Room 226T, Austin, Texas 78778-0001, (512) 936-3100.
Individuals may receive and review information that TWC collects about the individual by emailing to
open.records@twc.state.tx.us
or writing to TWC Open Records, 101 E. 15th St., Rm. 266, Austin, TX 78778-0001.
_____________________________________________________________________________________________
Page 1 of 1
CSC-004
PREVIOUS EDITIONS OF THIS FORM WILL NOT BE ACCEPTED
REV 10/14
Facility and Equipment Inspection Request
Texas Workforce Commission – Career Schools and Colleges
THIS FORM MUST ACCOMPANY your application for original certificate of approval, change of
address, additional classroom facility, and additional equipment/facilities for a new program.
Date facilities and equipment will be ready for inspection by TWC consultant:
(mm/dd/yyyy)
Submit this form with the following documents:
Floor Plan
Equipment Inventory List
Although we will schedule a survey visit as soon as possible after the "ready for inspection" date you provide,
there may be a delay of 30 days or more, depending upon your location.
Name of School:
Physical Address:
Street
City
State
Zip Code
Person to Contact/Phone Number:
All items below need to be available at your ORIGINAL site visit:
1.
Certificate of Occupancy for current address or letter of release from municipality.
2.
Current fire inspection by municipal authority, or letter of release and approval of private contractor
from municipal authority (last inspection date).
3.
Rental or lease agreement for school facilities, or statement of ownership for current address.
4.
Rental or lease agreement for instructional equipment and instructional aids or statement of ownership.
5.
Floor plan and school facilities are adequate for student capacity, and include: room numbers, pupil
capacities, break room, utilities, uses of rooms, room dimensions, restrooms, and record storage.
6.
Inventory of equipment & instructional aids adequate for student capacity and course objective.
7.
Current list of textbooks, software, and reference library, including: title(s), author/publisher, and
copyright dates.
8.
Sample of each certificate and/or diploma awarded to students.
9.
Narrative description of the school's way of taking and maintaining a positive record of attendance,
including when taken, symbols, methodology, and provisions for permanent maintenance; or evidence
of TWC approval of alternative method of accurately determining a student's last date of attendance for
refund purposes and accurate monitoring of absences.
10.
Sample of forms used to record attendance; and progress, grades and transcript forms (progress, grades
and transcript forms not required for seminar schools).
11.
Statement outlining the methods of payment available to students including, if applicable, terms of
agreements with lending institution(s), charges and true annual percentage rate(s), and the institution
name(s) and address(es).
12.
Examples of all advertising (yellow page, newspaper ad, brochures, audio/video scripts, etc.).
_____________________________________________________________________________________________
Completed forms, inquiries, or corrections to the individual information contained in this form shall be sent to the
TWC Career Schools and Colleges, 101 East 15th Street, Room 226T, Austin, Texas 78778-0001, (512) 936-3100.
Individuals may receive and review information that TWC collects about the individual by emailing to
open.records@twc.state.tx.us
or writing to TWC Open Records, 101 E. 15th St., Rm. 266, Austin, TX 78778-0001.
_____________________________________________________________________________________________
Page 1 of 1
CSC-004
PREVIOUS EDITIONS OF THIS FORM WILL NOT BE ACCEPTED
REV 10/14
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