Form Psr 0058 - Out-Of-State School Application For Certificate, Diploma, Associate Degree Or Advanced Degree Program - 2011

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STATE OF OHIO
BOARD OF CAREER COLLEGES AND SCHOOLS
30 EAST BROAD STREET, SUITE 2481
COLUMBUS, OHIO 43215-3414
(614) 466-2752 Fax (614) 466-2219
Toll Free (877) 275-4219
E-mail: bpsr@scr.state.oh.us Website:
OUT-OF-STATE SCHOOL APPLICATION FOR CERTIFICATE,
DIPLOMA, ASSOCIATE DEGREE OR ADVANCED DEGREE PROGRAM
NAME OF SCHOOL
ADDRESS (Number, Street, City, State, Zip)
ANTICIPATED START DATE:
TITLE OF PROGRAM FOR WHICH
APPROVAL IS SOUGHT:
LEVEL OF PROGRAM: Certificate _______ Diploma ______ Associate Degree ______ Advanced Degree ______
LENGTH OF PROGRAM
(WEEKS, MONTHS, YEARS)
APPROVED PROGRAM HOURS:
Clock ____________
OR
Semester Credit ___________
OR
Quarter Credit ____________
PROVIDE THE FOLLOWING INFORMATION BY ATTACHMENTS:
1. A copy of the program curriculum that was submitted to the home state approving
authority.
A copy of the letter of approval from the home state approving authority.
2.
NAME OF SCHOOL CONTACT PERSON
PHONE NUMBER
DATE
COMPLETION OF THIS FORM IS REQUIRED BY SECTION 3332 OF THE OHIO REVISED CODE. ALL ITEMS MUST BE COMPLETED!
ALL QUESTIONS MUST BE ANSWERED AND ALL MATERIALS REQUESTED MUST ACCOMPANY THE APPLICATION (FAILURE TO
DO SO WILL RESULT IN THE RETURN OF THE APPLICATION, WITHOUT ACTION, TO THE SCHOOL AND ANY FEES PAID ARE
SUBJECT TO FORFEITURE). YOU ARE REQUIRED TO FILL IN ALL BLANKS. IF NOT APPLICABLE, PLEASE PUT N/A.
PSR 0058 (Revised 10/11)

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