Office of Higher Education 947-1816POSTSECONDARY CAREESCHOOAPPLICATION - PDF document

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44444444444444444444Office of Higher Education 947-1816POSTSECONDARY CAREESCHOOAPPLICATION____ Occupational School ____ Barber or Hairdressing School ____ INITIAL APPROVAL REQUEST FOR REVISION OF AUTHORIZATION ____ RENEWAL OF APPROVAL ____ New program/Program Change

Program Tuition Changes ____ NEW BR
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/2 Rev) POSA AP Page 1 OffHigheEducatio
/2 Rev) POSA AP Page 1 OffHigheEducationand Hairdressing Schools , Hartford, CT 0610If you have any questions after reviewing the instructions and the forms, you may speak to a member of the Postsecondary Career School Staff at (860) 947-1816. BASIC INSTRUCTIONSRead the application carefullyA

nswer question/page, even if you must m
nswer question/page, even if you must mark “N/A” (Not Applicable)Provide all information as requested.Keep copies of all ms submitted.Complete and return all pages of the application. (For existing schools this must be 120 days prior to expirationauthorization.)Enclose check for the corr

ect amount indicated on page POSA AP Pag
ect amount indicated on page POSA AP Page 7.Return the completed application to the address indicated above.Please note that all signatures submitted to the Department to the Department must be original.IMPORTANTAll applications must be submitted on one-sided sheets of paper. Please do not double

sideany submissions.SPECIFIC ADDITIONA
sideany submissions.SPECIFIC ADDITIONAL INSTRUCTIONS The following are specific additional instructions for completing certain pages. Also review any direction that may be at the top of each form. NOTE FOR CURRENTLY APPROVED SCHOOLS: DO NOT SUBMIT CHANGES THAT WOULD BE CONSIDERED AS REVISIONS

SUBJECT TO THE PROVISIONS IN THE REGULA
SUBJECT TO THE PROVISIONS IN THE REGULATIONS AND THAT REQUIRE ACTION BY THE EXECUTIVE DIRECTOR OF THE OFFICE OF HIGHER EDUCATION IN THE APPLICATION PACKET FOR RENEWAL OF AUTHORIZATION.Submit any revisions separately, e.g.: changes in program curriculum, tuition price, hours of instruction, progra

m name, location offered, etc.)Name of
m name, location offered, etc.)Name of school (POSA AP Page 7Be certain to provide the complete name of the school. If the school is granted authorization the school name will be the name included on the Certificate of Authorization and published in the Office’s school directory. Ownership (

POSA AP Pages 7-8Disclose the type of o
POSA AP Pages 7-8Disclose the type of ownership of the school (sole proprietorship, partnership, board, association, limited liability company or corporation) and disclose on the form all ownership interests and percentage(s) (if applicable). Certificate of Incorporation or Certificate of Legal

Existence (POSA AP Page 8For a school t
Existence (POSA AP Page 8For a school that is owned by a newly-formed corporation or limited partnership, a copy of the Certificate of Incorporation or other business registration (e.g.: Certificate of Authority) that has been issued by the Connecticut Secretary of State must be filed. If the co

rporation or a Limited Partnership was f
rporation or a Limited Partnership was formed over a year prior to the application, then the school must obtain a “current”(issued within the last year and since any prior filing) Certificate of Legal Existence. These documents can be obtained from the Secretary of the State, attn. Administra

tive Offices, P.O. Box 150470, Hartford,
tive Offices, P.O. Box 150470, Hartford, Connecticut 06115-0470. Requests must be made in writing. For specific information on obtaining these documents call the office of the Secretary of State (860) 509-6212. Requests should be made well in advance of the application due date, since it may t

ake several weeks for a response. Appli
ake several weeks for a response. Application Fee (POSA AP Page 7The initial application fee should be mailed with the application. There is a fee for a new school, change of ownership, for the addition of a campus branch, and for renewal of authorization for the main campus and any branches.

There is no fee for the addition of clas
There is no fee for the addition of classroom sites (that is, where less than a full program is offered). Additional Facilities (POSA AP Page 9The school must list all locations other than the main campus address for the school, whether branch campus, additional classroom site, or student housin

g. (7/2013 Rev) POSA AP Page 2 New app
g. (7/2013 Rev) POSA AP Page 2 New applicant schools must provide an irrevocable Letter of Credit in the penal amount of payable to the Connecticut Private Occupational School Student Protection Account (P.O.S.S.P.A.). (The letter of Credit needs to be provided for twelve (12) years from the d

ate of initial approval or until the sch
ate of initial approval or until the school has paid into said "fund"). A sample Letter of Credit is enclosed. The Letter of Credit must be issued with its main office or branch located within the State of ConnecticutIf applicable, renewal applicant schools, who have not met the requirements of

Section 10a-22c(d) of the Connecticut G
Section 10a-22c(d) of the Connecticut General Statutes, must attach a copy of their irrevocable Letter of If not applicable, identify reason. twelve years have elapsed from date of in excess of has been paid into tudent protection fund. SEE SAMPLE Office of Higher Education ZONING OFFICER APPR

OVAL (Complete a separate form for each
OVAL (Complete a separate form for each location, including branches, classroom sites and student Complete this page as evidence that the school facility meets all applicable zoning requirements for the municipality in which it is located. NOTE: a new zoning approval is not needed if the branch

location, classroom site or student hous
location, classroom site or student housName of zoning officer Position name of school complete location address (not mail address) Description of all areas/rooms approved at the above address (including dormitory areas where on _______/____/_____ and found the facility to be in compliance with

all applicable zoning month
all applicable zoning month day year requirements and has obtained a Zoning Permit from the local Zoning Office for the above facility. If no Zoning Permit is required for the above facility, check here Comments, if any: Local Zoning Enforcement Officer TOWN: ________________

__________________ (NOTE: ZoningOfficer
__________________ (NOTE: ZoningOfficer may ev) POSA AP Page 15 Director must each complete this ls. Duplicate as appropriate. Name of School: ________________________________________________________ Name of School Owner:___________________________________________________ Name of School Direct

or______________________________________
or__________________________________________________ Name of Campus Director_________________________________________________ The executive director may deny a certificate of authorization if the person who owns or intends to operate a private occupational school other state, of larceny in violati

on of section 53a-122 or 53a-123; identi
on of section 53a-122 or 53a-123; identity theft in 139; or has a criminal record state, that the executive director be made in accordance with the provisions of sections 46a-79 to 46a-81, inclusive. Please note the section below must be completed and your signature notarized affirming the informa

tion is true and correct. Failure to c
tion is true and correct. Failure to complete this section will result in denial d of larceny ? _____yes _____no Have you ever been convicted of identity theft ? ____ Rev) POSA AP Page 16 Have you ever been convicted of a forgery ? _____yes _____no Do you have a criminal

record in Coher state ? _____yes _____n
record in Coher state ? _____yes _____no I, __________________________________, do swear or affirm that the statements are complete and correct to the best of my knowledge and belief. Signature: _______________________________Title: ___________________________ Print name: ________________________

___________ Sworn/affirmed and subscribe
___________ Sworn/affirmed and subscribed before me this ______ day of______________, 20__ Date of commission expiration: _____________ Rev) POSA AP Page 17 COMPLAINTS/INQUIRIES Attach a copy of the school's complaint/inquiry policy and procedures which is displayed, o

r will be displayed, in a clearly visibl
r will be displayed, in a clearly visible location at the school and at all branch and additional classroom sites. The policy and procedures must cover, at a minimum, the following: the filing of inquiries or complaints, with the Check here to indicate you have posted the school’s complaint p

olicy. Provide location complaint polic
olicy. Provide location complaint policy is located: ___________________________________ (7/20 Rev) POSA AP Page 40 DESIGNATION OF AGENT OF Name and Address of School___________________________________________________________ ___________________________________________________________ Name and

Title of Authorized Official: __________
Title of Authorized Official: ____________________________________________________ Name and Title of School’s Agent of Service: ______________________________________________ _____________________________________________ AddresSchool’s AgService_________________________________________________

___ (AgServi– contacperson responsible
___ (AgServi– contacperson responsible focommunication with the Department.) A.STATEMENAGENDESIGNATIONI, ______________________________________, [Director, President, Secretary, etthe above designate the person listed above to be the authorized school'service. As such, he/wilbe available

atimthe address noted above to receive
atimthe address noted above to receive certified letters sthe OffiHigEducatito the spursuato Secti10a-22a thru 10a-the Connecticut GenerStatutes, as amended by Public Act 11-48, established thereunder. furtaffirshould anotperson become the school's agservice, I shalimmediately notifOffiHig

Educatithrough the submission of a neDES
Educatithrough the submission of a neDESIGNATIOOF AGENOF SERVICE FORM. GNATURE OF AUTHORIZOFFICIAL: ___________________________DAT___________________________________________________________________________________ B.ACKNOWLEDGMENAGENDESIGNATIONacknowledge tthe designated agservifor and agrto compl

with althe requirements of Sections 10a-
with althe requirements of Sections 10a-22a thru 10a-the ConnectiGenerStatutes, as amended by Public Act 11-48, established thereunder. ___________________________________________________________________________________ SIGNATURE OF DESIGNATAGENT DATE: ___________________________________________

________________________________________
________________________________________ (7/2013 Rev) POSA AP Page Financial Forecast Cover Page Instructions450 Columbus Examined Name of 1.Financial forecast examined (Fin 1-2)2.Comparative forecasted Balance Sheet (Fin 3-4) completed3.Schedules A through F (Fin 5-6) completed4.Forecast

ed comparative income statement (Fin 7)
ed comparative income statement (Fin 7) completed5.Schedules G through H (Fin 8-9) completed6.Forecasted Statement of cash flows (Fin 10) comp7.Schedules I through M (Fin 11-12) completed8.Statement of affirmation (Fin 13) completed9.Statement of Fiscal Position (Fin 13) comp10.Auditor

7;s cover letter and footnotes included
7;s cover letter and footnotes included11.Name and address of school, where required, stated on each page12.Reporting period stated on each page13.If CONSOLIDATED FORECAST, consolidated report and separate14.All Items on COVER PAGE compEDIT CHECK has been completed by1) Name and Title ber 2

) Responsible Manager ber Rev) The
) Responsible Manager ber Rev) The enclosed forms are to be completed and submitteication. Please remember the following points in completing the enclosed forms: DEFINED AND USED INIn the comparative foreFINANCIAL FORECAST OF THE ENTIRE ORGANIZATION AND A SEPARATEIf you have any further qu

estions regarding the fina/201 Rev) 4
estions regarding the fina/201 Rev) 4444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444