Private Post Secondary Degree Granting Application

Private Post Secondary Degree Granting Application

Chapter 30 Application
Payment Received

Yes No
Payment Method
Check Number or ACH Date
Amount Paid
Institution Information
Name of Institution *
Date

Month Day Year
Date
Is the institution accredited through an accrediting body approved by the US Department of Education? *

Yes No
Name of accrediting association
Registration Period (July 1 through June 30 annually) *
Contact Name *

First Name Last Name
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Website/URL

Registered Agent

An agent is defined as anyone who represents the institution who solicits students in the State of Wyoming. This includes events such as career fairs or school visits.
Does the institution wish to license an agent? *

Yes No
By accepting the terms, the institution verifies that it has carefully reviewed the qualifications and the personal data of the agent and believes that he/she will perform as pledged above.

Payment Information

A $100 fee is required for each application. Additionally, please submit $100 for each registered agent. Checks should be sent to: Wyoming Department of Education Attn: Elaine Marces 122 W. 25th St. Suite E200 Cheyenne, WY 82002
Number of agents being registered today *
Cost of agent registrations
Base Application Fee
Total Amount Due
Method of Payment *

Check ACH Transfer Credit Card
Check Number
Date of ACH Transfer

Month Day Year
Date
Credit Card Processing
Signature *

Clear
Should be Empty:

Institution Information