KENTUCKY APPROVING AGENCY FOR VETERANS EDUCATION KCTCS, 300 North Main Street, Versailles, KY 40383 Telephone: (859) 256-3352 SAA 200 Application for Approval to Enroll Veterans and Other Eligible Persons in Accredited Courses & Non-Accredited Courses Include with your application: Two certified copies of the current school catalog or bulletin Statement of compliance with a two-year period of continuous operation Completed SAA 200 Application for Approval Section A School Information Section B Catalog Requirements Section C Policies and Tuition/Refund Information Section D List of Programs for Which Approval is Desired SAA-201 Non-Accredited School Catalog Review Form Publication(s) of a Non-Accredited School Catalog Review Form Catalog Certification Form VA Form 22-8794 Designation of Certifying Official VA Form 27-8206 Statement of Assurance for Equal Opportunity Laws VA Form 22-1919 Conflict of Interest Form Section E Instructors Qualification Form Catalog Certification Form See attached labels provided for your convenience Statement of Assurance for Equal Opportunity Laws VA Form 27-8206 Other Required Documentation Copy of Current Fire Marshall s Report or Certificate Copy of School s License with Kentucky Commission on Proprietary Education If applicable Copy of Cosmetology or Barbering License from Kentucky State Board For Proprietary Schools Only A Financial Statement that conforms to generally acceptable accounting principles either prepared by a C.P.A. or in-house by the individual who handles the financial documentation Copy of Liability Insurance with adequate protection of the school, employees, students and visitors Return completed application with two certified copies of school catalog and two copies of school publication to: Kentucky Approving Agency for Veterans Education 300 North Main Street Versailles KY 40383 Questions? Contact: Gwen Hacker (859) 256-3352 gwen.hacker@kctcs.edu
Section A School Information School Name Address Submitted by Title Phone Fax E-Mail Date Accredited Schools Only The course has been accredited and approved by a nationally recognized accrediting agency or association Yes No Name of Accrediting Agency Credit for such course is approved by the State Department of Education for credit towards a high school diploma. Yes No The course is conducted under 20 U.S.C 11-28 (vocational education). Yes No The course is accepted by the State Department of Education for credit for teacher s certificate or teacher s degree. Yes No Has the school met the 2-year period of operation law? Yes No If yes, attach a statement of compliance of the 2-year operation law. 1 P age
Section B Catalog requirements Requirement information can be found at the following o 38 CFR 21.4254 Code of Federal Regulation for Non-Accredited School o Manual 22-4: http://www.warms.vba.va.gov/m22_4.html o Education Index: Circulars, guides, letters: http://www.warms.vba.va.gov/tocindex.htm#c Catalog Year (s) Catalog Volume # Accredited Schools Only Effective Date Accreditation listings are found on pages Accredited Schools Only At the time of your institution s most recent review/reaffirmation by its institutional accreditation agency, were all programs, including degree, diploma Yes No Accredited Schools Only If no is indicated, have your programs that were not reviewed been subsequently accepted by the appropriate accrediting agency? Yes No If no, please explain: Are there any off-campus sites where veterans will enroll? Yes No Off campus site refers to school sites used as extensions of your campus, not sites where students have been sent for practical training/internships. If yes please list all campuses with address: 2 P age
Section C Policies and Tuition/Refund Information Indicate the page (s) for the following information 1. Minimum admission standards 2. Minimum requirements for graduation 3. Class Schedules 4. Calendars for all Certificates/Diplomas 5. Subjects or curriculum to be completed to achieve the vocational, educational, or professional objective 6. Grading system 7. Minimum grade considered satisfactory or passing 8. Minimum GPA or other determiner for graduation 9. Notification of student s grades & progress 10. Policy on Academic Probation/Unsatisfactory Progress 11. Academic Suspension policy 12. Re-entrance policy after Academic suspension/dismissal 13. Policy regarding student conduct (Attach Handbook or other supporting documents if not included in catalog.) 14. Conditions for conduct probation or dismissal 15. Conditions for re-admission after conduct dismissal 16. Class Attendance Policy 17. Policies regarding granting credit for previous education/training (prior credit), and advance standing 18. Catalog must contain a statement regarding progress records kept by the school and furnished the student 19. Tuition/Fees Schedule 20. PUBLIC INSTITUTIONS ONLY: Fee Deferment Statement for Students Using GI Bill Benefits (TCA 49-7-104) 21. School Refund Policy [Non-accredited institutions must have a 100% pro-rata policy in accordance with 38 CFR 21.4254(c)(13) and 21.4255] 3 P age
Section C continued 22. Policies on Leave, Absences, Class Cuts, Tardiness, Make-Up Work and Interruptions for Unsatisfactory Attendance 23. Statement of compliance with Equal Opportunity Laws 24. Are all students issued a catalog, brochure or bulletin and a copy of the rules, regulations, course outlines, progress standards, etc. upon enrolling? Yes No (If no, please explanation) 25. Non-Accredited Institutions must include a description of available space, facilities and equipment if not in catalog (attach if necessary) 26. Name of the school s governing body 27. Names of school officials 28. Names of school faculty 29. Calendar of school indicating legal holidays 30. Calendar of school indicating begin & end dates of semesters 31. Calendar of school indicating add/drop dates 32. Statement that school does not use erroneous, deceptive practices 4 P age
Section D List of Programs for which Approval is Desired Approval to enroll veterans and other eligible persons is requested for the following courses (degrees, majors, programs) being offered by this school: Note: Catalogs must contain course outlines for each program for which approval is requested, showing subjects or units in each program, approximate time in clock hours for each subject or unit, and course descriptions. Programs not listed on this form will not be approved and cannot be certified. New programs initiated between catalogs must be submitted separately. Attach a separate sheet if necessary. Program Type Clock Hours Student Ratio Page 5 P age
Section D continued Official List of Courses Approved for Practical Training/Internships. (Accreditation recognized by Department of Education) 38 CFR 21.4265 Course Number Name of Course Page 6 P age
Section D continued Official List of Courses Approved for Co-Operative Training (National Accreditation recognized by the Department of Education) 38 CFR 21.4233 Course Number Name of Course Page 7 P age
Section E Instructors Qualification Form Additional data bearing qualifications may be written on a separate sheet and attached if necessary. Instructors Name Home Address City State & Zip Code Subjects you will teach General Education Years of High School Completed Date Last Attended Non-College Degree School Completed (Cosmetology or Tech School) Date Last Attended Years of College Completed Date Last Attended Institution Degree Major Field Minor Field Years of Graduate Work Teaching Experience School Dates Place Subject 8 P age
Section E continued Teacher Training Dates Courses Institution Technical Training Dates Specialty Institution Trade Experience Dates Trade Job Title Place Held I certify that the information provided is true and correct Printed Name Signature Date 9 P age
*************** It is certified that all information submitted with this application is true and correct and the following approval criteria will be met (should be applicable to all students, but must be met for all students receiving G.I. Bill educational benefits): Adequate records will be kept to show the progress (grades) of the student toward his/her educational or vocational objective. If the student withdraws before completing a course, the last day of attendance will be recorded and the VA notified within 30 days of termination. A written record will be maintained of any education or training the student may have had which can be credited toward the student's objective. This education will be evaluated and credit allowed toward the objective as applicable. Policies of progress and conduct will be enforced (these policies describe conditions under which the student will be terminated due to lack of progress toward his/her objective or engaging in unacceptable conduct). Attendance records will be maintained for students enrolled in resident courses not leading to a standard college degree (there is a policy describing circumstances under which a student will be terminated due to lack of attendance). Required reports will be submitted to the Department of Veterans Affairs advising them of a student's beginning and ending dates, last day of attendance if there is a termination or withdrawal, educational or vocational objective rate of pursuit, and credit allowed for previous education and training that may shorten the student's course. Advertisements, websites, and other school publications will not use the phrase VA Approved or any other statement that can be construed as false or misleading advertising with regard to veterans or veterans educational assistance benefits. Representatives of the Department of Veterans Affairs and the Kentucky Approving Agency for Veterans Education will be permitted to visit the school for the purpose of reviewing records, interviewing students, inspecting the facilities, and evaluating the instructional processes. This institution does not provide any commission, bonus, or other incentive payment based directly indirectly on success in securing enrollments or financial aid to any persons or entities engaged in any student recruiting or admission activities or in making decisions regarding the award of student financial assistance. 10 P age
In accordance with the requirements of title 38 Code of Federal Regulations, this is to verify that this school catalog, bulletin or brochure, and/or the attached material submitted as a basis for this approval and application, are certified true and correct in content an policy, and that this school complies with all statements of assurance listed above as they apply to this school ant it s training programs, and id accredited, with all addition information for accredited institutions items listed above. Name of School/Establishment School s Address/Physical Location Printed Name Signature/Title Date ***********************************Official Use Only*********************************** This school has been inspected and found adequate for the training of eligible persons under Chapters 30, 32, 33, 35, and 36, Section 3676, Title 38, United States Code; and Chapter 1606 and 1607, Title 10, United States Code. SAA Consultant Signature Date This school has been found, upon investigation and in accordance with provisions of this application and supplemental documents, to meet the established approval criteria. SAA Director Signature Date 11 P age
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5. THE FOLLOWING ARE DESIGNATED AS CERTIFYING OFFICIALS OF THIS SCHOOL OR TRAINING ESTABLISHMENT (Continued) C. FOR POSTSECONDARY EDUCATIONAL INSTITUTIONS ONLY - OFFICIALS DESIGNATED TO SIGN THE SCHOOL PORTION OF VA FORM 22-1990T, APPLICATION AND ENROLLMENT CERTIFICATION FOR INDIVIDUALIZED TUTORIAL ASSISTANCE, ARE: NO. NAME TITLE SIGNATURE (1) (2) (3) 6. REMARKS It is acknowledged that each of the individuals designated as certifying officials must successfully complete online training for new certifying officials prior to being granted access to VA's certification system. It is hereby certified that the Department of Veterans Affairs will be notified of any changes in the designations shown on this form as they occur. 7. SIGNATURE AND TITLE OF DESIGNATING OFFICIAL 8. DATE PENALTY - The law provides that whoever makes any statement of a material fact knowing it to be false shall be punished by fine or imprisonment or both. PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, Vocational Rehabilitation and Employment Records - VA, and published in the Federal Register. An example of a routine use (e.g., VA sends educational forms or letters with a veteran's identifying information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for VA to obtain further information as may be necessary from the school for VA to properly process the veteran's education claim or to monitor his or her progress during training). Your obligation to respond is required to obtain or retain education benefits. VA cannot recognize you as the proper certifying official unless the information is furnished as required by existing law (38 U.S.C. 3680(g)). The responses you submit are considered confidential (38 U.S.C. 5701). Any information provided by applicants, recipients, and others is subject to verification through computer matching programs with other agencies. RESPONDENT BURDEN: We need this information to identify you as the certifying official for your school or job training establishment when reporting pursuit of training for veterans and other eligible persons (38 U.S.C. 3684). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 10 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo. gov/public/do/pramain. If desired, you can call 1-888-GI-BILL-1 (1-888-442-4551) to get information on where to send comments or suggestions about this form. 13 P age
VA Department of Veterans Affairs CONFLICTING INTEREST CERTIFICATION FOR PROPRIETARY SCHOOLS ONLY NAME AND ADDRESS OF INSTITUTION PURPOSE: This form informs individuals that the law has restrictions concerning any potential conflict of interests. (See certifications (1) and (2) below). These certifications not only apply to chapters 31 and 36 of Title 38, U.S.C., buy also apply to the following programs administered by the Department of Veterans Affairs (VA): Program MGIB VEAP DEA MGIB-SR Montgomery GI Bill-Active Duty Educational Assistance (Chapter 30 of Title 38, U.S. Code) Veterans' Educational Assistance (Chapter 35 of Title 38, U.S. Code) Dependents' Educational Assistance (Chapter 35 of Title 38, U.S. Code) Montgomery GI Bill-Selected Reserve Educational Assistance Program (Chapter 1606, formerly known as Chapter 106, of Title 10, U.S. Code) EAPP Educational Assistance Pilot Program (Section 903 of Public Law 96-342) (1) PROPRIETARY PROFIT SCHOOLS ONLY The law prohibits employees of the Veterans Affairs (VA) and the State Approving Agency (SAA) from owning any interest in an educational institution operated for profit. In addition, the law prohibits these employees from receiving any wages, salary, dividends, gifts or services from private profit schools. These provisions may be waived if the VA determines that no detriment will result to the government or to veterans and eligible persons enrolled (38 U.S.C. 3683). Please list below those VA and SAA employees known by you who may have a potential conflict of interest under this provision. If there are none, please enter the word none. NAME AND TITLE OF EMPLOYEE(S) DESCRIPTION OF ASSOCIATION WITH SCHOOL (2) ALL PROPRIETARY SCHOOLS 38 CFR 21.4202(c) prohibits the approval of any veteran or eligible person in any proprietary school of which the veteran or trainee is an official authorized to sign certificates of enrollment or verification/certifications of attendance, an owner or an officer. Please list below the names and VA file numbers (claim or Social Security Numbers) of any certifying officials, owners or officers of your school who receive VA education assistance based on enrollment in your school. If there are none, please enter the word none. NAME AND TITLE OF EMPLOYEE(S) VA FILE NUMBER DATES OF ENROLLMENT WITH YOUR SCHOOL FROM TO I DO HEREBY CERTIFY that the entries above are true and correct to the best of my knowledge. I agree to immediately notify the VA of any potential violations of the above prohibitions. SIGNATURE OF PRESIDENT OR CHIEF ADMINISTRATIVE OFFICIAL OF SCHOOL TITLE DATE 14 P age