Private Postsecondary Educational Institution License Bond ...



PRIVATE POSTSECONDARY EDUCATIONAL INSTITUTION LICENSE BOND (10)

KNOW BY ALL THOSE PRESENT THAT AS PRINCIPAL,

|NAME OF POSTSECONDARY EDUCATIONAL INSTITUTION |BOND NUMBER |

|ADDRESS |CITY/STATE/ZIP |

|AND |

|NAME OF SURETY COMPANY | |

|HOME OFFICE ADDRESS |CITY/STATE/ZIP |

as Surety, are held and firmly bound unto the STATE OF NEVADA, Commission on Postsecondary Education, in the sum of ___________________________________ DOLLARS, for the payment of which sum, well and truly be made, we bind ourselves, our successors and assigns, jointly and firmly by these present.

THE condition of this obligation is such that whereas Principal is desirous of obtaining a license to operate a Private Postsecondary Educational Institution pursuant to the provisions of Nevada Revised Statutes Chapter 394, as amended and the rules and regulations of the Commission on Postsecondary Education adopted pursuant thereto, commencing on _____________________, 20_____.

NOW, THEREFORE, if the above bounden Principal shall faithfully comply with all of the provisions of said statutes, rules and regulations and amendments, this obligation shall be null and void; otherwise to remain in full force and effect. This bond is provided by the Principal and surety pursuant to the provisions of Nevada Revised Statutes Chapter 394 and rules and regulations of the Commission on Postsecondary Education, and amendments of such statutes or rules and regulations in effect during the life of this bond. The requirements of such statutes, rules and regulations, or amendments thereto, and the terms, conditions and provisions thereof are and shall be deemed incorporated in and made a part of this bond as though fully set forth herein. The surety herein reserves the right to withdraw as such surety except as to any liability already incurred or accrued hereunder, and may do so upon the giving of written notice of such withdrawal to the Commission on Postsecondary Education; provided, however, that no withdrawal shall be effective for any purpose until thirty (30) days have elapsed from and after the receipt of such notice by said Commission on Postsecondary Education and further provided that no withdrawal shall in any way affect the liability of said surety arising out of the obligation herein created prior to the expiration of such period of thirty (30) days.

UPON notice by the Commission on Postsecondary Education with supporting evidence to Surety of claims against Principal, Surety is held to resolve such claims within a sixty (60) days period from date of notice by the Commission on Postsecondary Education.

IN WITNESS THEREOF, the Principal and said surety have hereunto caused this instrument to be executed at

________________________________________________________ this _______ day of ____________________, 20____.

|PRINCIPAL (NAME OF POSTSECONDARY EDUCATIONAL INSTITUTION |SIGNATURE OF OWNER/DATE |

|NAME OF SURETY COMPANY |SIGNATURE OF SURETY COMPANY REPRESENTATIVE |

STATE OF _________________________________} County __________________________________}

ON this _________ day of ______________, 20____, did before me, ____________________________, a Notary Public, personally appear and properly identify to me, Principal whose name appears above and signed this instrument of surety in my presence.

IN WITNESS THEREOF, I have hereunto set my hand and affixed my official seal at my office, in said County and State, this _______ day of _________________, 20____.

_____________________________________________

Notary Public

SEAL:

DEGREE COMPLETION REQUIREMENTS (30J)

Complete this form for each program you are requesting approval to offer. You may use any format that includes the same information as this form.

|COLLEGE or UNIVERSITY NAME |PROGRAMMATIC ACCREDITING BODY (if applicable) |

|NAME OF PROGRAM |TOTAL CREDITS REQUIRED |COST PER CREDIT |

|ENTRANCE REQUIREMENTS |MIN AGE |HS/GED? |ADMISSIONS TEST? (IF YES, TITLE & MINIMUM SCORE) |

| |OTHER (SKILLS, PRIOR CREDIT, ETC.) |

|LIST ALL EACH REQUIRED COURSE |

|TITLE |CREDITS |TITLE |CREDITS |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

COURSE CONTENT – FORM 30K

Complete this form for each course required to complete the program listed on the 30J.

|PROGRAM TITLE |

| |

| |

| |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

|COURSE TITLE |CREDITS |DESCRIPTION |

DISTANCE EDUCATION PROGRAMS OFFERED (30f)

Degree Granting

LIST ALL PROGRAMS OFFERED VIA DISTANCE EDUCATION

|School Name |Address |School Representative |

| | |Contact | |

| | |Email | |

| | |Telephone | |

|Program or Degree Name |Online |Online Live |Hybrid |

| | | | |

|Course Name and Number Offered - Distance Education |

| | | | |

| | | | |

| | | | |

| | | | |

|Program or Degree Name |Online |Online Live |Hybrid |

| | | | |

|Course Name and Number Offered - Distance Education |

| | | | |

| | | | |

| | | | |

| | | | |

|Program or Degree Name |Online |Online Live |Hybrid |

| | | | |

|Course Name and Number Offered - Distance Education |

| | | | |

| | | | |

| | | | |

| | | | |

|CPE Licensing Use Only | |

|NAME/ADDRESS OF SCHOOL |

|WEB SITE OF SCHOOL |EMAIL ADDRESS OF DIRECTOR |

|CHARACTER REFERENCES |

|NAME |PHONE NUMBER |□ PROFESSIONAL |

| | |□ PERSONAL |

|NAME |PHONE NUMBER |□ PROFESSIONAL |

| | |□ PERSONAL |

|NAME |PHONE NUMBER |□ PROFESSIONAL |

| | |□ PERSONAL |

Attach the following:

► Evidence of Nevada residency (drivers license, voter registration, lease or rent agreement, etc.)

► Evidence of two years of administrative experience in an accredited institution of higher learning.

I certify that

► I have received a copy of and am familiar with NRS 394 and NAC 394.

► I am a bona fide resident of Nevada.

► The information on this form and those attached are true and correct.

SIGNATURE OF APPLICANT/DATE

ACADEMIC DIRECTOR (40a)

Complete this form for the academic director of each licensed program – NAC 394.480.

|NAME OF SCHOOL |NAME OF ACADEMIC DIRECTOR |

|PROGRAMS ASSIGNED TO THIS ACADEMIC DIRECTOR: |

|HIGH SCHOOL ATTENDED |CITY/STATE |DATE COMPLETED |

|POSTSECONDARY SCHOOL |CITY/STATE |AREA OF STUDY |AWARD/DATE |

|POSTSECONDARY SCHOOL |CITY/STATE |AREA OF STUDY |AWARD/DATE |

|PAST EMPLOYER/ADDRESS/PHONE # |JOB TITLE |INCLUSIVE DATES |

|PAST EMPLOYER/ADDRESS/PHONE # |JOB TITLE |INCLUSIVE DATES |

|PAST EMPLOYER/ADDRESS/PHONE # |JOB TITLE |INCLUSIVE DATES |

|NAME OF CHARACTER REFERENCE |PHONE NUMBER |□ PROFESSIONAL |

| | |□ PERSONAL |

|NAME OF CHARACTER REFERENCE |PHONE NUMBER |□ PROFESSIONAL |

| | |□ PERSONAL |

|NAME OF CHARACTER REFERENCE |PHONE NUMBER |□ PROFESSIONAL |

| | |□ PERSONAL |

Note: Instructor qualifications differ based on the level of instruction. See NAC 394.485 for exact requirement.

Attach the following:

► High school diploma or postsecondary degree obtainment and;

► Evidence of two years of work or teaching experience in the subject assigned; or,

► Evidence of a bachelor degree in a field related to assigned courses if assigned undergraduate academic degree; or

► Evidence of a master degree in a field related to assigned courses if assigned master degree; or,

► Evidence of doctorate degree in a field related to assigned courses if assigned doctorate degree.

I certify that the information on this form and those attached are true and correct.

SIGNATURE OF APPLICANT/DATE

INSTRUCTOR (40b)

Complete this form for each instructor and attach required documents – NAC 394.485.

|INSTRUCTOR NAME |DATE HIRED |

|NAME OF SCHOOL |

|LIST ALL COURSES/SUBJECTS ASSIGNED TO TEACH – ELABORATE ON ANY ACRONYM: |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

|CHECK BELOW AS APPLICABLE AND SUBMIT COPIES OF THE REQUIRED DOCUMENTS (RETAIN ORIGINALS): |

| |Instructor is assigned to teach non-degree granting courses, classes or subjects. |

| |Attach letters from previous employers indicating at least two years of teaching or work experience for each course, class or subject assigned to|

| |teach. The letters must describe the work or teaching responsibilities in detail and provide contact information to verify employment. Attach |

| |evidence of completion of high school, equivalent or postsecondary education. Provide documentation of any credential/license required to teach |

| |assigned subject. |

| |Instructor is assigned to teach technical courses at the associate-degree level. (Example: MicroSoft Access© for students enrolled in an |

| |Associate program.) |

| |Attach letters from previous employers indicating at least two years of teaching or work experience for each course, class or subject assigned to|

| |teach. The letters must describe the work or teaching responsibilities in detail and provide contact information to verify employment. |

| |Attach evidence of completion of high school equivalent or postsecondary education. Provide documentation of any credential/license required to |

| |teach assigned subject. |

| |Instructor is assigned to teach undergraduate degree granting courses, classes or subjects. |

| |Attach an official academic transcript from an accredited postsecondary educational institution indicating the award of a bachelor’s degree |

| |related to the assigned courses. Provide documentation of any credential/license required to teach assigned subject. |

| |Instructor is assigned to teach graduate degree granting courses, classes or subjects. |

| |Attach an official academic transcript from an accredited postsecondary educational institution indicating the award of a master’s degree related|

| |to the assigned courses. Provide documentation of any credential/license required to teach assigned subject. |

Background Investigation Requirements

As of July 1, 2014, the process for submitting fingerprints to the Commission must be as described below. Any fingerprint application that does not follow the process below will be rejected and considered not to be in compliance with NRS 394.465, subjecting the school to fines.

Process If Taken By Law Enforcement (Manually)

|Step 1 |Obtain and complete CPE Form 40c. The form must be signed by both the applicant and a school official. |

|Step 2 |Mail or bring the completed CPE Form 40c to the Commission on Postsecondary for initial processing. CPE Staff must sign the |

| |form prior to Step 3. |

|Step 3 |Haven finger prints taken by law enforcement. The completed fingerprint card MUST be placed into an envelope, sealed, and |

| |initialed by the agency taking the prints. |

|Step 4 |Return the sealed envelope and a money order or company check for $36.25 (Starting October 1, 2016) (made payable to the |

| |Department of Public Safety), to: |

| |CPE |

| |8778 S Maryland PW Ste 115 |

| |Las Vegas, NV, 89123 |

Process If Taken By and Submitted Electronically

|Step 1 |Obtain and complete CPE Form 40c. The form must be signed by both the applicant and a school official. |

|Step 2 |Mail or bring the completed CPE Form 40c to the Commission on Postsecondary for initial processing. CPE Staff must sign the |

| |form prior to Step 3. |

|Step 3 |Prints must be taken by a Department of Public Safety approved vendor. Click here for a list of approved vendors. |

|Step 4 |Ensure vendor completes SECTION 4 of CPE Form 40c. |

|Step 5 |Return the ORIGINAL completed form to CPE. |

CPE Form 40c – Background Investigation

SECTION 1/FINGERPRINT BACKGROUND WAIVER – COMPLETE ALL FIELDS

|APPLICANT’S LAST NAME (PRINT LEGIBLY) |APPLICANT’S FIRST NAME |

| | |

| | |

|As an applicant who is the subject of a Federal Bureau of Investigation (FBI) fingerprint-based criminal history record check for a noncriminal justice |

|purpose you have certain rights which are discussed below. |

|1. You must be notified by the Commission on Postsecondary Education (CPE) that your fingerprints will be used to check the criminal history records of|

|the FBI and the State of Nevada. |

|2. Authority: The FBI’s acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C 534. |

|Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to Pub. L. 92-544, Presidential |

|Executive Orders, and federal regulations. Providing your fingerprints and associated information is voluntary; however, failure to do so may affect |

|completion or approval of your application. |

|3. Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprint-based background|

|checks. Your fingerprints and associated information/biometrics may be provided to employing, investigating, or otherwise responsible agency, and /or |

|the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI’s Next Generation Identification (NGI) system or its successor |

|systems (including civil, criminal, and latent fingerprint repositories) or other available records of the employing, investigating, or otherwise |

|responsible agency. The FBI may retain your fingerprints and associated information/biometrics in NGI after the completion of this application and, |

|while retained, your fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI. |

|4. Routine Uses: During the processing of this application and for as long thereafter as your fingerprints and associated information/biometrics are |

|retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as permitted by the Privacy Act |

|of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the Routine Uses for the NGI system and the |

|FBI’s Blanket Routine Uses. Routine uses include, but are not limited to, disclosures to: employing governmental or authorized non-governmental agencies|

|responsible for employment, contracting, licensing, security clearances, and other suitability determinations; local, state, tribal, or federal law |

|enforcement agencies; criminal justice agencies; and agencies responsible for national security or public safety. |

|5. If you have a criminal history record, the officials making a determination of your suitability for the job, license or other benefit for which you |

|are applying must provide you the opportunity to complete or challenge the accuracy of the information in the record. You may review and challenge the |

|accuracy of any and all criminal history records which are returned to the submitting agency. The proper forms and procedures will be furnished to you |

|by the Nevada Department of Public Safety, Records Bureau upon request. If you decide to challenge the accuracy or completeness of you FBI criminal |

|history record, Title 28 of the Code of Federal Regulations Section 16.34 provides for the proper procedure to do so: |

|16.34 - Procedure to obtain change, correction, or updating of identification records. If, after reviewing his/her identification record, the subject |

|thereof believes that it is incorrect or incomplete in any respect and wishes changes, corrections or updating of the alleged deficiency, he/she should |

|make application directly to the agency which contributed the questioned information. The subject of a record may also direct his/her challenge as to |

|the accuracy or completeness of any entry on his/her record to the FBI, Criminal Justice Information Services (CJIS) Division ATTN: SCU, Mod. D-2, 1000 |

|Custer Hollow Road, Clarksburg, WV 26306. The FBI will then forward the challenge to the agency which submitted the data requesting that agency to |

|verify or correct the challenged entry. Upon the receipt of an official communication directly from the agency which contributed the original |

|information, the FBI CJIS Division will make any changes necessary in accordance with the information supplied by that agency. |

|6. Based on 28 CFR § 50.12 (b), officials making such determinations should not deny the license or employment based on information in the record until|

|the applicant has been afforded a reasonable time to correct or complete the record or has declined to do so. |

|7. You have the right to expect that officials receiving the results of the fingerprint-based criminal history record check will use it only for |

|authorized purposes and will not retain or disseminate it in violation of federal or state statute, regulation or executive order, or rule, procedure or|

|standard established by the National Crime Prevention and Privacy Compact Council. |

|8. I hereby authorize Commission on Postsecondary Education to submit a set of my fingerprints to the Nevada Department Public Safety, Records Bureau |

|for the purpose of accessing and reviewing State of Nevada and FBI criminal history records that may pertain to me. |

|In giving this authorization, I expressly understand that the records may include information pertaining to notations of arrest, detainments, |

|indictments, information or other charges for which the final court disposition is pending or is unknown to the above referenced agency. For records |

|containing final court disposition information, I understand that the release may include information pertaining to dismissals, acquittals, convictions,|

|sentences, correctional supervision information and information concerning the status of my parole or probation when applicable. |

|9. I hereby release from liability and promise to hold harmless under any and all causes of legal action, the State of Nevada, its officer(s), agent(s)|

|and/or employee(s) who conducted my criminal history records search and provided information to the submitting agency for any statement(s), omission(s),|

|or infringement(s) upon my current legal rights. I further release and promise to hold harmless and covenant not to sue any persons, firms, |

|institutions or agencies providing such information to the State of Nevada on the basis of their disclosures. I have signed this release voluntarily and|

|of my own free will. |

| |

|A reproduction of this authorization for release of information by photocopy, facsimile or similar process, shall for all purposes be as valid as the |

|original. |

| |

|In consideration for processing my application I, the undersigned, whose name and signature voluntarily appears below; do hereby and irrevocably agree |

|to the above. |

|SIGNATURE OF APPLICANT |DATE SIGNED |

|CPE Form 40c – Background Investigation (Continued) |

|SECTION 1/FINGERPRINT BACKGROUND WAIVER CONTINUED – COMPLETE ALL FIELDS |

|APPLICANT’S LAST NAME (PRINT LEGIBLY) |

| |

| |

|APPLICANT’S FIRST NAME |

| |

| |

|POSITION AT SCHOOL |

| |

| |

| |

|APPLICANT’S ADDRESS |

| |

| |

|APPLICANT’S CITY/STATE/ZIP |

| |

| |

| |

| |

| |

|APPLICANT’S E-MAIL ADDRESS |

|APPLICANT’S HOME OR CELL PHONE # |

| |

| |

|LIST ALL FELONY OR CRIMES OF MORAL TURPITUDE CONVICTIONS. USE ADDTIONAL PAPER IF NEEDED. IF NONE, WRITE NONE IN YEAR FIELD. |

| |

|YEAR |

| |

| |

|CITY/STATE |

| |

| |

|CONVICTED OF |

| |

| |

|SENTENCE |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|SECTION 2/SCHOOL INFORMATION |

|NAME OF SCHOOL |PRINTED NAME OF SCHOOL OFFICIAL |SCHOOL OFFICIAL’S POSTION |

| | |SCHOOL OFFICIALS PHONE NUMBER |

|I certify that I have reviewed the information on this form as provided by the applicant. |

| |

| |

| |

| |

|SIGNATURE OF SCHOOL OFFICIAL/DATE SIGNED |

|SECTION 3/CPE INFORMATION |

|Commission on Postsecondary Education |SIGNATURE OF CPE STAFF |NV920410Z |

|2800 E. St. Louis | |880236 |

|Las Vegas NV 89104 | |NRS 394.465 |

|702-486-7330 | | |

|cpe. | | |

| |INSTRUCTIONAL ADMINISTRATIVE FINANCIAL SCHOOL DIRECTOR PERSONNEL OFFICER |

| |COUNSELOR ADMISSION REPRESENTATIVE FINANCIAL AID OFFICER |

| |SOLICITOR CANVASSER SURVEYOR AGENT |

|SECTION 4/ENTITY TAKING FINGERPRINTS (Do not process without CPE staff signature and stamp) |

|STAMP/SIGNATURE OF ENTITY TAKING AND SUBMITTING FINGERPRINTS |DATE |

| | |

| | |

| | |

| | |

| |TCN # |

Return completed form to CPE by mail or email to sbeckett@detr.

-----------------------

Applicant:

______________ ____________

Initial Date Page 1 of 2

Applicant:

______________ ____________

Initial Date Page 2 of 2

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download