Training Program Application

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Training Provider Name *

Education/Training Program Name *

Address where coursework will be delivered *

Address Line 1

Address Line 2

City

State

Zip Code

Classification of Instructional Program (CIP) Code *

Education/Training Program Description *

This program of study or training services has the following potential outcome(s) (select all that apply) *

An industry-recognized certificate or certification
A certificate of completion of an apprenticeship
A license recognized by the State or Federal Gov’t
AA/AS Degree
BA/BS Degree
A community college certificate of completion
A secondary school diploma or its equivalent
Employment
A measurable skills gain leading to a credential
A measurable skills gain leading to employment

Does this program leads to a credential or degree? *

Type of credential/degree: *

High School Diploma/FED/HSE Diploma
AA/AS Degree
BA/BS Degree
Occupational Skills License
Occupational Skills Certificate or Credential
Post-Graduate Degree
No credential received, individual received training
Other (Describe)

Type of Credential Attained - Other (Describe here) *

Is this training considered “Green Job Training”? *

Financial Aid Available? *

Pell Grant
Institutional Scholarship
Federal Loan
None
Other (Describe)

Financial Aid Available - Other (Describe here) *

Program Prerequisites *

High School Diploma or Equivalent
Associate’s Degree
Bachelor’s Degree
Course(s)
Combination of Education and Course(s)
None

Minimum Class Size *

Maximum Class Size *

Accessibility (check all that apply) *

On-Site Parking
Public Transportation
Disabled Student Access
Sign Language
Other Languages
Other (Describe)

Accessibility - Other (Describe here) *

Resources Required? *

Describe any equipment used in this program and its adequacy and availability in 800 characters or less:

Provide information on program/course curriculum by listing Course Codes and Corresponding Course Titles for up to six classes below. *

List up to four occupations relevant to this program/course: *

Is this a Credit Earned Program? *

Number of Credits/Units Earned

Credit Earned Duration

Semester
Quarter

Credentialing Body *

Bureau for Private Postsecondary Education (BPPE)
Bureau for Private Postsecondary Education Exempt
Western Association of Schools and Colleges (WASC) – Accrediting Commission for Schools
WASC – Senior College and University Commission
WASC – Accrediting Commission for Community and Junior Colleges
California Department of Education (CDE)
Exemption under Internal Revenue Service Section 501(c)(3)
Other (Describe)

Credentialing Body - Other (Describe here) *

Class Time (in hours) *

Lab Time (in hours) *

Other time (in hours) *

Class Frequency *

Daily
Bi-Weekly
Weekly
Monthly
Quarterly
Semester
Tri-semester
Annual
Bi-Annual
Bi-Monthly

Reporting Program Length – Clock/Contact Hours *

Note: Clock/contact hours are the total number of actual hours per week a student spends attending class or other instructional activities that count toward completing a program of study.

Reporting Program Length – Full-time Weeks *

Note: Full-time weeks indicates the length of the program in weeks, as completed by a full-time student.

Program Format *

In-Person
On-line, E-learning, or Distance Learning
Hybrid or Blended Program

Primary Duration Type *

Semesters/Terms
Weeks
Hours
Months

Number/Amount Associated with Duration Type *

(e.g., number of semesters/terms, weeks, hours or months)

Schedule Intensity *

Full-time
Part-time

Weekly Schedule *

(e.g., M-W-F, T-TH, W night)

Classes Offered (Check all that apply) *

Day
Night
Weekend
Summer

Provide information on the total cost associated with participation in this program/course, and then break the total cost down by the categories outlined below *

Tuition/Fees

Books

Tools

Other

Describe "Other"

If an amount is included in the “Other” category, describe what these costs are

The following information is also required in order to list this training program on the ETPL

For the time period July 1, 2021 – June 30, 2022

Total # Served *

The total number of active students in this training program during the time period, regardless of when they began the program.

Total # Exited *

The total number of students who exited the program for whatever reason during the time period (including successful completions, withdrawals, transfers, etc.).

Total # Completed *

Note: This number is a subset of the “Total # Exited” and must be less than or the same as the number reported directly above. This number is a subset of Total # Exited and should include ONLY those who successfully completed the program. This number must be less than or equal to the “Total # Exited” provided under the previous question.

By entering my name below, I acknowledge and affirm that the information I have provided in this form is true, accurate, and correct to the best of my knowledge and belief. I acknowledge that providing false or misleading information may lead to the rejection of this application and the potential disqualification from future application opportunities.

Name *

First

Last

Title *

Phone Number *

Date *

By submitting this form, you are affirming that the description of this training program and the costs shown above are currently available in/on my catalog, brochure, website, or information packet and are available upon request. In addition, I agree to provide information on the completion status of all students registered for this program for the program years it is active on the State of California’s ETPL.