Kelly Wuest
Administrator
8778 South Maryland Parkway Suite 115
Las Vegas, Nevada 89120
702-486-7330 P
702-486-7340 F
Commission on Postsecondary Education
Dear Applicant:
Enclosed is the required application that must be completed for out-ofstate institutions that solicit students in Nevada. Only those schools
that are accredited will be considered for approval. Nevada law defines
“accredited“ as having met the standards of a U.S. Department of
Education-recognized accrediting body.
Please make sure you read each form carefully and complete and/or
attach the necessary documents. If you have any questions, please
call this agency or contact me via email at kdwuest@cpe.state.nv.us.
Regulations pertaining to this authorization can be reviewed on line at
http://www.cpe.state.nv.us. Applicable regulations are contained in
NRS and NAC Chapters 394.
Kelly Wuest
Administrator
INITIAL AUTHORIZATION TO EMPLOY AGENTS IN NEVADA
Complete this checklist as indicated and submit with the application.
ENTER NAME OF SCHOOL BELOW:
WEB SITE:
ENTER SCHOOL’S STREET ADDRESS BELOW:
SCHOOL’S CITY STATE ZIP BELOW:
ENTER NAME OF CONTACT PERSON BELOW:
PHONE NUMBER OF CONTACT PERSON
EMAIL ADDRESS OF CONTACT PERSON
ENTER SCHOOL MAILING ADDRESS IF DIFFERENT FROM ABOVE:
INITIALS
FORM#
FORM TITLE
10
PRIVATE POSTSECONDARY EDUCATIONAL INSTITUTION BOND
Complete the bond form and submit with rider. NOTE: Surety bond MUST BE executed by an agent licensed and
residing in Nevada. (NRS 394.480)
40c
Background Investigation Form
41
Nevada Contact
60
OWNERSHIP
Complete as appropriate.
Current copy of your catalog.
One thousand five hundred dollar ($1,500) non-refundable application fee payable to the “STATE OF NEVADA
TREASURER”
Evidence of Accreditation
Provide evidence of accreditation for each program you seek approval or evidence of institutional approval. Accreditor
must be approved by the U.S. Department of Education.
Competency/skills checklist used to evaluate student performance
Submit a sample copy of the checklist/evaluation document that will be used to evaluate students in experiential courses.
I declare that the postsecondary educational institution described in this application is in full compliance with the civil
rights act as amended (Title VI) and the Americans with disabilities act and that the institution will in no way discriminate
on the basis of race, color, creed, age, sex, or disability and I hereby certify that the information provided on this form
and the attachments hereby submitted are complete and accurate.
TYPE NAME OF INDIVIDUAL SIGNING BELOW:
SIGNATURE OF SCHOOL OFFICIAL/DATE SIGNED
PRIVATE POSTSECONDARY EDUCATIONAL INSTITUTION LICENSE BOND - FORM 10
KNOW BY ALL THOSE PRESENT THAT AS PRINCIPAL,
NAME OF POSTSECONDARY EDUCATIONAL INSTITUTION
BOND NUMBER
ADDRESS
CITY/STATE/ZIP
AND
NAME OF SURETY COMPANY
HOME OFFICE ADDRESS
CITY/STATE/ZIP
as Surety, are held and firmly bound unto the STATE OF NEVADA, Commission on Postsecondary Education, in the sum of
$10,000 (Ten Thousand Dollars), for the payment of which sum, well and truly be made, we bind ourselves, our successors and
assigns, jointly and firmly by these present.
THE condition of this obligation is such that whereas Principal is desirous of obtaining a license to operate a Private Postsecondary Educational
Institution pursuant to the provisions of Nevada Revised Statutes Chapter 394, as amended and the rules and regulations of the Commission on
Postsecondary Education adopted pursuant thereto, commencing on _____________________, 20_____.
NOW, THEREFORE, if the above bounden Principal shall faithfully comply with all of the provisions of said statutes, rules and regulations and
amendments, this obligation shall be null and void; otherwise to remain in full force and effect. This bond is provided by the Principal and surety
pursuant to the provisions of Nevada Revised Statutes Chapter 394 and rules and regulations of the Commission on Postsecondary Education, and
amendments of such statutes or rules and regulations in effect during the life of this bond. The requirements of such statutes, rules and regulations,
or amendments thereto, and the terms, conditions and provisions thereof are and shall be deemed incorporated in and made a part of this bond as
though fully set forth herein. The surety herein reserves the right to withdraw as such surety except as to any liability already incurred or accrued
hereunder, and may do so upon the giving of written notice of such withdrawal to the Commission on Postsecondary Education; provided,
however, that no withdrawal shall be effective for any purpose until thirty (30) days have elapsed from and after the receipt of such notice by said
Commission on Postsecondary Education and further provided that no withdrawal shall in any way affect the liability of said surety arising out of
the obligation herein created prior to the expiration of such period of thirty (30) days.
UPON notice by the Commission on Postsecondary Education with supporting evidence to Surety of claims against Principal, Surety is held to
resolve such claims within a sixty (60) days period from date of notice by the Commission on Postsecondary Education.
IN WITNESS THEREOF, the Principal and said surety have hereunto caused this instrument to be executed at
________________________________________________________ this _______ day of ____________________, 20____.
PRINCIPAL (NAME OF POSTSECONDARY EDUCATIONAL INSTITUTION
SIGNATURE OF OWNER/DATE
NAME OF SURETY COMPANY
SIGNATURE OF SURETY COMPANY REPRESENTATIVE
STATE OF _____________________________________}
County ________________________________________}
ON this _________ day of ______________, 20____,before me, ____________________________, a Notary Public in and for said
County and State, personally appeared ___________________________________________, known to me to be the person whose
name is subscribed to the within instrument as Attorney-in-fact of the ____________________________, and acknowledged to me
that he subscribed the name of said company thereto as Principal, and his own name as Attorney-in-fact.
IN WITNESS THEREOF, I have hereunto set my hand and affixed my official seal at my office, in said County and State, this
_______ day of _________________, 20____.
_____________________________________________
Notary Public
SEAL:
Nevada Contact – Form 41
NAME OF CONTACT
PHONE NUMBER
POSITION/TITLE
EMAIL ADDRESS OF CONTACT
MAILING ADDRESS OF CONTACT
NAME OF SCHOOL
SCHOOL WEB SITE
NAME OF APPOINTING AUTHORITY
SIGNATURE OF APPOINTING AUTHORITY/DATE
Agent Permit Application
Return to CPE 20 Days Prior to Expiration Date
NAME OF AGENT
ADDRESS
CITY/ST/ZIP
SSN
DATE CURRENT AGENT LICENSE EXPIRES
RENEWAL DUE TO CPE
CHILD SUPPORT QUESTIONAIRE – Permit will be denied if one of the following is not marked.
I am not subject to a court order for the support of a child
I am subject to a court order for the support of one or more children and am in compliance with the order or am in compliance with a
plan approved by the District Attorney or other public agency enforcing the order for the repayment of the amount owed pursuant to
the order; or
I am subject to a court order for the support of one or more children and am not in compliance with the order or am not in compliance
with a plan approved by the District Attorney or other public agency enforcing the order for the repayment of the amount owed
pursuant to the order.
NEVADA BUSINESS LICENSE QUESTIONAIRE – Permit will be denied if the following section is not completed. Be advised that your personal identifiable
information will be turned over to the Nevada Secretary of State.
NOTE: The Commission on Postsecondary Education is not the arbiter of determining whether the applicant needs a business license. Information about the
Nevada business license can be found on the Secretary of State’s website at: http://nvsos.gov/
I have a Nevada business license number assigned by the Nevada Secretary of State upon compliance with the provisions of NRS Chapter 76 and the
number is: _______________________________________________
I have applied for a Nevada business license with the Nevada Secretary of State upon compliance with the provision of NRS Chapter 76 and my
application is pending.
I do not have a Nevada State Business License.
I CERTIFY I HAVE NOT BEEN CONVICTED OF A FELONY OR CRIME OF MORAL TURPITUDE WITHIN THE PREVIOUS 12 MONTHS.
SIGNATURE OF APPLICANT/DATE SIGNED
NAME OF INSTITUTION
ADDRESS
BONDING COMPANY
CITY/STATE/ZIP
BOND NUMBER
I CERTFY THAT OUR MOST RECENT CATALOG AND ENROLLMENT AGREEMENT HAVE BEEN SUBMITTED TO THE NEVADA COMMISSION ON POSTSECONDARY
EDUCATION.
TYPED NAME OF SCHOOL OFFICIAL
SIGNATURE OF SCHOOL OFFICIAL/DATE SIGNED
RETURN COMPLETED FORM AND A $200.00 (NON-REFUNDABLE RENEWAL APPLICATION FEE FOR EACH INSTITUTION REPRESENTED)
CHECK PAYABLE TO THE STATE OF NEVADA TREASURER AND RETURN TO:
ATTN: AGENT APPLICATION
COMMISSION ON POSTSECONDARY EDUCATION
8778 SOUTH MARYLAND PARKWAY, SUITE 115
LAS VEGAS, NEVADA 89123
Background Investigation Requirements
As of July 1, 2014, the process for submitting fingerprints to the Commission must be as
described below. Any fingerprint application that does not follow the process below will be
rejected and considered not to be in compliance with NRS 394.465, subjecting the school to
fines.
Process If Taken By Law Enforcement (Manually)
Step 1
Obtain and complete CPE Form 40c. The form must be signed by both
the applicant and a school official.
Step 2
Mail or bring the completed CPE Form 40c to the Commission on
Postsecondary for initial processing. CPE Staff must sign the form prior
to Step 3.
Step 3
Haven finger prints taken by law enforcement. The completed
fingerprint card MUST be placed into an envelope, sealed, and initialed
by the agency taking the prints.
Step 4
Return the sealed envelope and a money order or company check for
$38.25 starting February 1, 2015 (made payable to the Department of
Public Safety), to:
CPE
8778 S Maryland PW Ste 115
Las Vegas, NV, 89123
Process If Taken By and Submitted Electronically
Step 1
Obtain and complete CPE Form 40c. The form must be signed by both
the applicant and a school official.
Step 2
Mail or bring the completed CPE Form 40c to the Commission on
Postsecondary for initial processing. CPE Staff must sign the form prior
to Step 3.
Step 3
Prints must be taken by a Department of Public Safety approved vendor.
Click here for a list of approved vendors.
Step 4
Ensure vendor completes SECTION 4 of CPE Form 40c.
Step 5
Return the ORIGINAL completed form to CPE.
CPE Form 40c – Background Investigation
SECTION 1/FINGERPRINT BACKGROUND WAIVER
APPLICANT’S LAST NAME (PRINT LEGIBLY)
APPLICANT’S FIRST NAME
POSITION AT SCHOOL
APPLICANT’S ADDRESS
APPLICANT’S CITY/ST/ZIP
APPLICANT’S HOME OR CELL PHONE #
LIST ALL FELONY OR CRIMES OF MORAL TURPITUDE CONVICTIONS. USE ADDTIONAL PAPER IF NEEDED. IF NONE, WRITE NONE IN YEAR FIELD
YEAR
CITY/STATE
CONVICTED OF
SENTENCE
As an applicant who is the subject of a Federal Bureau of Investigation (FBI) fingerprint-based criminal history record check for a noncriminal justice purpose you have certain rights which are discussed below.
1. You must be notified by the Commission on Postsecondary Education that your fingerprints will be used to check the criminal history records of the FBI and the State of Nevada.
2. If you have a criminal history record, the officials making a determination of your suitability for the job, license or other benefit for which you are applying must provide you the opportunity to complete or challenge
the accuracy of the information in the record. You may review and challenge the accuracy of any and all criminal history records which are returned to the submitting agency. The proper forms and procedures will be
furnished to you by the Nevada Department of Public Safety, Records Bureau upon request. If you decide to challenge the accuracy or completeness of you FBI criminal history record, Title 28 of the Code of Federal
Regulations Section 16.34 provides for the proper procedure to do so:
16.34 - Procedure to obtain change, correction, or updating of identification records.
If, after reviewing his/her identification record, the subject thereof believes that it is incorrect or incomplete in any respect and wishes changes, corrections or updating of the alleged deficiency, he/she
should make application directly to the agency which contributed the questioned information. The subject of a record may also direct his/her challenge as to the accuracy or completeness of any entry on
his/her record to the FBI, Criminal Justice Information Services (CJIS) Division ATTN: SCU, Mod. D-2, 1000 Custer Hollow Road, Clarksburg, WV 26306. The FBI will then forward the challenge to the agency
which submitted the data requesting that agency to verify or correct the challenged entry. Upon the receipt of an official communication directly from the agency which contributed the original information,
the FBI CJIS Division will make any changes necessary in accordance with the information supplied by that agency.
3. Based on 28 CFR § 50.12 (b), officials making such determinations should not deny the license or employment based on information in the record until the applicant has been afforded a reasonable time to correct
or complete the record or has declined to do so.
4. You have the right to expect that officials receiving the results of the fingerprint-based criminal history record check will use it only for authorized purposes and will not retain or disseminate it in violation of federal
or state statute, regulation or executive order, or rule, procedure or standard established by the National Crime Prevention and Privacy Compact Council.
5. I hereby authorize Commission on Postsecondary Education to submit a set of my fingerprints to the Nevada Department Public Safety, Records Bureau for the purpose of accessing and reviewing State of Nevada
and FBI criminal history records that may pertain to me. In giving this authorization, I expressly understand that the records may include information pertaining to notations of arrest, detainments, indictments,
information or other charges for which the final court disposition is pending or is unknown to the above referenced agency. For records containing final court disposition information, I understand that the release may
include information pertaining to dismissals, acquittals, convictions, sentences, correctional supervision information and information concerning the status of my parole or probation when applicable.
6. I hereby release from liability and promise to hold harmless under any and all causes of legal action, the State of Nevada, its officers, agents and/or employees who conducted my criminal history records search and
provided information to the submitting agency for any statement(s), omission(s), or infringement(s) upon my current legal rights. I further release and promise to hold harmless and covenant not to sue any persons,
firms, institutions or agencies providing such information to the State of Nevada on the basis of their disclosures. I have signed this release voluntarily and of my own free will.
A reproduction of this authorization for release of information by photocopy, facsimile or similar process, shall for all purposes be as valid as the original. In consideration for processing my application I, the
undersigned, whose name and signature voluntarily appears below; do hereby and irrevocably agree to the above.
SIGNATURE OF APPLICANT
DATE SIGNED
SECTION 2/SCHOOL INFORMATION
NAME OF SCHOOL
PRINTED NAME OF SCHOOL OFFICIAL
SCHOOL OFFICIAL’S POSTION
SCHOOL OFFICIALS PHONE NUMBER
I certify that I have reviewed the information on this form as provided by the applicant.
SIGNATURE OF SCHOOL OFFICIAL/DATE SIGNED
SECTION 3/CPE INFORMATION
Commission on Postsecondary
Education
8778 S Maryland PW #115
Las Vegas NV 8912
PRINTED NAME OF CPE STAFF
SIGNATURE OF CPE STAFF
SECTION 4/ENTITY TAKING FINGERPRINTS (do not process without CPE staff signature and stamp)
STAMP/SIGNATURE OF ENTITY TAKING AND SUBMITTING FINGERPRINTS
DATE
TCN #
OWNERSHIP – FORM 60
Check the applicable organization of your institutions and provide applicable information.
SOLE PROPRIETORSHIP
NAME OF OWNER
AREA CODE & PHONE NUMBER
FULL MAILING ADDRESS
NAME OF BUSINESS
AREA CODE & PHONE NUMBER
BUSINESS ADDRESS
PARTNERSHIP – submit a copy of partnership agreement and list all partners.
PARTNER NAME
ADDRESS
PHONE NUMBER
PARTNER NAME
ADDRESS
PHONE NUMBER
PARTNER NAME
ADDRESS
PHONE NUMBER
PARTNER NAME
ADDRESS
PHONE NUMBER
CORPORATION – list all who have 10% or more interest. Attach corporation certificate and if foreign, copy
of filing with the Nevada Secretary of State. Include a listing of all officers.
CORPORATE OFFICE/POSITION
ADDRESS
PHONE NUMBER
CORPORATE OFFICE/POSITION
ADDRESS
PHONE NUMBER
CORPORATE OFFICE/POSITION
ADDRESS
PHONE NUMBER
PUBLIC INSTITUTION – Attach a copy of your state charter