David Perlman - Marian University



David Perlman | |8778 South Maryland Parkway Suite 115 | |

| Administrator | |Las Vegas, Nevada 89123 |

|dperlman@cpe.state.nv.us | |Ph: 702 486-7330 |

| | |Fx: 702 486-7340 |

| | | |

Commission on Postsecondary Education

cpe.state.nv.us

Dear Applicant:

Enclosed is the required application that must be completed for out-of-state institutions that provide education to individuals in Nevada. Only those schools that are accredited will be considered for approval. Nevada law defines “accredited“ as having met the standards of a U.S. Department of Education-recognized accrediting body.

Please make sure you read each form carefully and complete and/or attach the necessary documents. If you have any questions, please call this agency or contact me via email at dperlman@cpe.state.nv.us.

Regulations pertaining to this authorization can be reviewed on line at . Applicable regulations are contained in NRS and NAC Chapters 394.

David Perlman

Administrator

INITIAL AUTHORIZATION TO OPERATE EXPERIENTIAL COURSES IN NEVADA

Complete this checklist as indicated and submit with the application.

|ENTER NAME OF SCHOOL BELOW: |WEB SITE: |

| | |

|ENTER SCHOOL’S STREET ADDRESS BELOW: |SCHOOL’S CITY STATE ZIP BELOW: |

| | |

| | |

| | |

|ENTER NAME OF CONTACT PERSON BELOW: |PHONE NUMBER OF CONTACT PERSON |

| | |

| | |

| |EMAIL ADDRESS OF CONTACT PERSON |

|ENTER SCHOOL MAILING ADDRESS IF DIFFERENT FROM ABOVE: |

|INITIALS |FORM# |FORM TITLE |

| |10 |PRIVATE POSTSECONDARY EDUCATIONAL INSTITUTION BOND |

| | |Complete the bond form and submit with rider. |

| |60 |OWNERSHIP |

| | |Complete as appropriate. |

| |61 |Certification |

| |Current copy of your catalog (pdf version preferred). |

| |Fifteen hundred dollar ($1,500) non-refundable application fee payable to the “STATE OF NEVADA TREASURER” |

| |Evidence of accreditation |

| |Provide evidence of accreditation for each program you seek approval or evidence of institutional approval. Accreditor must be approved by the |

| |U.S. Department of Education. |

| |Competency/skills checklist used to evaluate student performance |

| |Submit a sample copy of the checklist/evaluation document that will be used to evaluate students in experiential courses. |

| |Approval of Nevada Licensing Board as applicable |

| |I declare that the postsecondary educational institution described in this application is in full compliance with the civil rights act as |

| |amended (Title VI) and the Americans with disabilities act and that the institution will in no way discriminate on the basis of race, color, |

| |creed, age, sex, or disability and I hereby certify that the information provided on this form and the attachments hereby submitted are complete|

| |and accurate. |

|TYPE NAME OF INDIVIDUAL SIGNING BELOW: |

|SIGNATURE OF SCHOOL OFFICIAL/DATE SIGNED |

PRIVATE POSTSECONDARY EDUCATIONAL INSTITUTION LICENSE BOND - FORM 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 $10,000 (Ten Thousand 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____,before me, ____________________________, a Notary Public in and for said County and State, personally appeared ___________________________________________, known to me to be the person whose name is subscribed to the within instrument as Attorney-in-fact of the ____________________________, and acknowledged to me that he subscribed the name of said company thereto as Principal, and his own name as Attorney-in-fact.

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:

OWNERSHIP – FORM 60

Check the applicable organization of your institutions and provide applicable information.

| |SOLE PROPRIETORSHIP |

|NAME OF OWNER |AREA CODE & PHONE NUMBER |

|FULL MAILING ADDRESS |

|NAME OF BUSINESS |AREA CODE & PHONE NUMBER |

|BUSINESS ADDRESS |

| |PARTNERSHIP – submit a copy of partnership agreement and list all partners. |

|PARTNER NAME |ADDRESS |PHONE NUMBER |

|PARTNER NAME |ADDRESS |PHONE NUMBER |

|PARTNER NAME |ADDRESS |PHONE NUMBER |

|PARTNER NAME |ADDRESS |PHONE NUMBER |

| |CORPORATION – list all who have 10% or more interest. Attach corporation certificate and if foreign, copy |

| |of filing with the Nevada Secretary of State. Include a listing of all officers. |

|CORPORATE OFFICE/POSITION |ADDRESS |PHONE NUMBER |

|CORPORATE OFFICE/POSITION |ADDRESS |PHONE NUMBER |

|CORPORATE OFFICE/POSITION |ADDRESS |PHONE NUMBER |

| |PUBLIC INSTITUTION – Attach a copy of your state charter |

OWNERSHIP – FORM 61

The following is not an all inclusive list of Nevada state licensing boards or commissions which may require acceptance of your training if the training leads to licensure.

Complete this form as appropriate.

[ ] I certify the training that will be offered online to Nevada residents does not lead to licensure by a Nevada state agency.

[ ] I certify the training that will be offered online to Nevada residents leads to licensure by a Nevada state agency and approval is attached.

SIGNATURE OF SCHOOL REPRESENTATIVE/DATE SIGNED

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