Form 1 "Application for an Inaugural Authorization to Operate a Private Postsecondary Career School in Nebraska - 4 Programs or Less" - Nebraska

What Is Form 1?

This is a legal form that was released by the Nebraska Department of Education - a government authority operating within Nebraska. As of today, no separate filing guidelines for the form are provided by the issuing department.

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Download Form 1 "Application for an Inaugural Authorization to Operate a Private Postsecondary Career School in Nebraska - 4 Programs or Less" - Nebraska

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APPLICATION FOR AN INAUGURAL AUTHORIZATION TO OPERATE A PRIVATE POSTSECONDARY CAREER SCHOOL IN NEBRASKA # 1 FORM -- 4 PROGRAMS OR LESS
Name of School:
Administrative Director of School:
School Address including Street, City, State, Zip:
Home Address of Administrative Director, including Zip:
Mailing Address of School including Zip:
Enclosed are completed Administrative Director and Instructor Qualification Forms.
Telephone:
E-Mail Address:
Web Site:
Attached is a statement verifying that none of the following persons have any felony convictions: (1) any persons having twenty-five (25) percent or more
ownership of the applicant school (2) resident director (3) administrative staff members.
The ownership of this school is sole proprietorship. The name and home address of the proprietor are listed below.
The ownership of this school is partnership. The names and titles of all partners with their respective home addresses are listed below.
The ownership of this school is a corporation. The name and address of the corporation, and the names and titles of corporate officers with their respective home addresses are listed below.
FISCAL YEAR END DATE: ______/______
Name of Proprietor, Partnership, or Corporation:
Home Address of Proprietor/Partner or of Corporation, including Zip Code:
Name and Title:
Home Address:
Name and Title:
Home Address:
Enclosed are the names, addresses, and current status of all schools of which the applicant has previously owned any interest in, and currently owns any interest in, and a declaration as to whether any of these schools were ever denied accreditation, licensing, or
authorization to operate from any governmental body or accrediting agency.
Enclosed are copies of the owners’ financial statements (balance sheet & income statement) and the most recent federal and state
Enclosed is a surety bond or other agreement acceptable to the Department ($20,000) and the non-refundable statutory fee of
income tax returns.
$360.00 plus $135.00 per program made payable to the Nebraska Department of Education.
`
Program Title
Student/
Days of Attendance
Program
Mode of
Maximum
Program Length
Program
Tuition
Total
Teacher
Objective
Delivery
Enrollment
Measurement
Charge
Tuition
Ratio
Size
Per
Charge
Listed below are the programs which will be offered.
Quarter/
Per
(Enclosed for each program listed, is a course outline, a course description, and a class
Clock
Credit
Semester
Program
schedule showing dates and hours of attendance, not given in the catalog.
Hours
Hours
Attached is a list of major items/tools/ equipment available or which will be made
available. (Included is information relative to year, make, and model.)
Copies of the following data are enclosed: 1) all enrollment agreements or contract forms to be used with the students; 2) samples of a student transcript and forms which will be used to monitor student attendance, academic progress, conduct, and placement; 3)
policy regarding the maintenance of student records as required in Rule 41; 4) sample of the credentials (certificate/diploma) that will be awarded to students at successful completion of the program of study; 5) media advertising and promotional literature and
brochures; 6) school catalog containing the information required by Rule 41; 7) floor plan of the school showing classrooms, students’ lounge, rest rooms, etc.; 8) evidence of facility ownership or lease for at least one year; 9) inspection reports from local and state
regulatory agencies indicating that the premises and conditions under which students will work and study meet sanitation and safety requirements; 10) application, fee, and bond for an agent’s permit
If the applicant school is owned by an individual, this application should be signed by the owner. If owned by a partnership, it should be signed
Send completed form and supporting documents to Program Director, Private Postsecondary Career Schools and
by the managing partner. If owned by a corporation or association, by one of the authorized officers.
Veterans Education, Nebraska Department of Education, P.O. Box 94987, Lincoln, NE 68509-4987.
I have read this application, and the statements therein made are true to the best of my knowledge, information, and belief.
Signature (Written)
Signature (Typed/printed)
This form should not be reworded.
Title:
APPLICATION FOR AN INAUGURAL AUTHORIZATION TO OPERATE A PRIVATE POSTSECONDARY CAREER SCHOOL IN NEBRASKA # 1 FORM -- 4 PROGRAMS OR LESS
Name of School:
Administrative Director of School:
School Address including Street, City, State, Zip:
Home Address of Administrative Director, including Zip:
Mailing Address of School including Zip:
Enclosed are completed Administrative Director and Instructor Qualification Forms.
Telephone:
E-Mail Address:
Web Site:
Attached is a statement verifying that none of the following persons have any felony convictions: (1) any persons having twenty-five (25) percent or more
ownership of the applicant school (2) resident director (3) administrative staff members.
The ownership of this school is sole proprietorship. The name and home address of the proprietor are listed below.
The ownership of this school is partnership. The names and titles of all partners with their respective home addresses are listed below.
The ownership of this school is a corporation. The name and address of the corporation, and the names and titles of corporate officers with their respective home addresses are listed below.
FISCAL YEAR END DATE: ______/______
Name of Proprietor, Partnership, or Corporation:
Home Address of Proprietor/Partner or of Corporation, including Zip Code:
Name and Title:
Home Address:
Name and Title:
Home Address:
Enclosed are the names, addresses, and current status of all schools of which the applicant has previously owned any interest in, and currently owns any interest in, and a declaration as to whether any of these schools were ever denied accreditation, licensing, or
authorization to operate from any governmental body or accrediting agency.
Enclosed are copies of the owners’ financial statements (balance sheet & income statement) and the most recent federal and state
Enclosed is a surety bond or other agreement acceptable to the Department ($20,000) and the non-refundable statutory fee of
income tax returns.
$360.00 plus $135.00 per program made payable to the Nebraska Department of Education.
`
Program Title
Student/
Days of Attendance
Program
Mode of
Maximum
Program Length
Program
Tuition
Total
Teacher
Objective
Delivery
Enrollment
Measurement
Charge
Tuition
Ratio
Size
Per
Charge
Listed below are the programs which will be offered.
Quarter/
Per
(Enclosed for each program listed, is a course outline, a course description, and a class
Clock
Credit
Semester
Program
schedule showing dates and hours of attendance, not given in the catalog.
Hours
Hours
Attached is a list of major items/tools/ equipment available or which will be made
available. (Included is information relative to year, make, and model.)
Copies of the following data are enclosed: 1) all enrollment agreements or contract forms to be used with the students; 2) samples of a student transcript and forms which will be used to monitor student attendance, academic progress, conduct, and placement; 3)
policy regarding the maintenance of student records as required in Rule 41; 4) sample of the credentials (certificate/diploma) that will be awarded to students at successful completion of the program of study; 5) media advertising and promotional literature and
brochures; 6) school catalog containing the information required by Rule 41; 7) floor plan of the school showing classrooms, students’ lounge, rest rooms, etc.; 8) evidence of facility ownership or lease for at least one year; 9) inspection reports from local and state
regulatory agencies indicating that the premises and conditions under which students will work and study meet sanitation and safety requirements; 10) application, fee, and bond for an agent’s permit
If the applicant school is owned by an individual, this application should be signed by the owner. If owned by a partnership, it should be signed
Send completed form and supporting documents to Program Director, Private Postsecondary Career Schools and
by the managing partner. If owned by a corporation or association, by one of the authorized officers.
Veterans Education, Nebraska Department of Education, P.O. Box 94987, Lincoln, NE 68509-4987.
I have read this application, and the statements therein made are true to the best of my knowledge, information, and belief.
Signature (Written)
Signature (Typed/printed)
This form should not be reworded.
Title: