Post Secondary Proprietary School Application
Chapter 1 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)
*
Please Select
2022-2023
2023-2024
2024-2025
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
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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 in accordance with Wyoming statutes and Rules and Regulations.
Advertising Policy
If the institution chooses to advertise that they are licensed by the Wyoming Department of Education, the student must sign the following statement: "I understand that (Name of Institution) is licensed with the Wyoming Department of Education in accordance with W.S. 21-2-401 through 21-2-407 and that neither the Department of Education nor the Wyoming State Board of Education accredits or endorses any course of study being offered by (Name of Institution)."
Institution agrees to abide by this advertising policy, W.S. 21-2-401 through 21-2-407, and Chapter 1 Rules and Regulations
*
Yes
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Staffing
List all administrators, faculty and staff
Institution certifies that the employee's qualifications and personnel data have been carefully reviewed and verifies that the employee meets the necessary qualification or the position he/she holds
*
Please explain reason for dismissal or revocation for staff member (if applicable)
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Supporting Documentation
Please attach PDF version
Attendance Record Form
*
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Enrollment Contract Including Tuition Fees and Refund Policy
*
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Probationary Academic/Discipline Policy
*
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Description of Instructional Methods/Outlines
*
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Course Outlines for Each Course
*
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Current Financial Statement
*
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Mission Statement
*
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Sample Graduation Certificate
*
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Additional Documentation
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Payment Information
A $200 fee is required for each application. Additionally, please submit $100 for each registered agent. Checks should be sent to: Wyoming Department of Education Attn: Brenna Harris 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
Your institution has obtained a $10,000 Original Performance Bond with valid dates of July 1 – June 30 of the registration year and sent the original documentation with wet signatures and a raised notary seal to the Wyoming Department of Education.
Yes
No
Signature
*
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