ACCREDITING BUREAU OF HEALTH EDUCATION SCHOOLS 7777 Leesburg Pike, Suite 314 N. · Falls Church, Virginia 22043 Tel. 703/917.9503 · Fax 703/917.4109 · E-Mail: info@abhes.org APPLICATION FOR PROGRAMMATIC ACCREDITATION Please review carefully and provide all of the information requested as applicable to the institution/program. Incomplete applications (i.e., blank areas requiring information) will be returned for resubmission, which could delay the accreditation process. Sponsoring Institution: ABHES ID Code (Renewal Applicants Only): Institutional Accreditor: Expiration Date Mailing Address: City: State: Telephone Number: Zip: Fax Number: Name of on-site administrator: (Specify Dr., Mr., Ms., Mrs.) Title of on-site administrator: Email of on-site administrator: Name of program supervisor: (Specify Dr., Mr., Ms., Mrs.) Title of program supervisor: Email Address of program supervisor: Institution Website Address: ***ABHES correspondence and updates are provided via e-mail. Contact ABHES immediately should there be changes to the e-mail addresses provided. Based upon review of the basic requirements outlined in the Accreditation Manual, Chapter II, Section B, Programmatic Eligibility, we believe that our Medical Assistant, Medical Laboratory Technology, and/or Surgical Technology program meets the criteria; and, therefore, submit an application for an initial or renewed grant of programmatic accreditation by the Accrediting Bureau of Health Education Schools (ABHES). A separate application must be submitted for each of the following applicable programs for which programmatic accreditation is being sought: 1) Medical Assistant; 2) Medical Laboratory Technology; and/or 3)Surgical Technology. For institutions with multiple-credentials offered in the same program area, complete only one application to include all credential levels. Place the curser in 1. and type X where it applies or to insert the information requested. This application is for (check one): Initial Accreditation Renewal of Accreditation Specify (check one): Medical Assistant; Medical Laboratory Technology; Application for Programmatic Accreditation Revised January 2015 Surgical Technology 2. The program is offered at (check one): A public or private institution at the postsecondary level accredited by an agency recognized by the U.S. Department of Education or Council on Higher Education Accreditation (CHEA) whose principal activity is education; A hospital or laboratory-based training school; A Veteran Administration (V.A.) hospital, rehabilitation institution, or a federally-sponsored Armed Forces program 3. Is the program vocational in nature and designed to lead to employment? Yes 4. Does the institution utilize a separate classroom for the program that is being considered for programmatic accreditation? No Yes No Refer to Chapter II of the ABHES Accreditation Manual for a definition of a separate classroom. NOTE: If the classroom is within reasonable walking distance, it is considered a part of the main or non-main campus. Also, facilities used to provide distance education methods of delivery are exempt from meeting the requirements for separate classroom space. If yes, provide the following information for the separate classroom: Copy and paste the table below for each separate classroom location. Street Address: City: State: Zip: Phone Number: Distance from the campus to which it is assigned: A. Is the staff at the separate classroom limited primarily to instruction? Yes No B. Does the separate classroom utilize the same administration from the campus to which it is assigned? C. Do students spend an adequate amount of time at the campus to which is assigned to avail themselves to the administrative, student, and educational services offered by the institution? Yes No Yes No D. Are all permanent records maintained at the campus to which it is assigned? E. Is the separate classroom within customary and reasonable commuting distance of the campus to which is it assigned? Yes No Yes No F. Is this the only separate classroom assigned to this campus for the applicable program? Yes No If answered “NO” to any of the questions A-F above, explain: 5. The sponsoring institution has been legally operating and continuously providing instruction as an institution since (Month & Year)? 6. Identify oversight agency(ies) and approval expiration(s) as applicable Table will expand as needed to accommodate full listing.: NOTE: The sponsoring institution must evidence that it is licensed, chartered, or approved to provide education beyond the secondary level under the laws and regulations of the state or territories in which it is located. Institution/Program Application for Programmatic Accreditation Revised January 2015 Agencies/Organizations Expiration Date 7. Does the institution operate* its program in a state(s) other than the state in which the institution is physically located? *Note: The regulatory definition of “operate” varies by state, as do licensure and authorization requirements. Some states require approvals for any institution delivering educational programs within their state (including via distance education), regardless of on-ground presence; other states require approvals based upon on-ground triggers, such as student participation in clinical experiences or interest meetings, employment of local faculty, or placement of local advertising, among others. Lack of applicable state authorization may impact a student's ability to become credentialed in certain professions. It is the responsibility of the school to determine when it is necessary to obtain approvals from the states in which it is operating, as applicable. Yes If yes, complete the chart below: Table will expand as needed to accommodate full listing. Identify the state(s) where the program *operates. Does the state require authorization to *operate the program? Yes / No If yes, identify the date the state approval was awarded. 8. Has state approval of the sponsoring institution or program ever been removed? (e.g., withdrawal, suspension, revocation, relinquishment) If yes, explain: 9. Has accreditation ever been denied or removed (e.g., denial, withdrawal, suspension, revocation, relinquishment) from the sponsoring institution by this or any other accrediting agency? If yes, explain: Yes Yes No No An applicant must describe any current, previous, or final action for which it is the subject, including probationary status, by a recognized institutional accrediting agency or state agency potentially leading to the withdrawal, suspension, revocation, or termination of accreditation or licensure. Action on the application will be stayed until the action by the other accrediting agency or state agency is final. Include a copy of the action letter from the agency with this application. Further, the institution must provide evidence of compliance with ABHES requirements and standards relative to the action. 10. Has a lawsuit been filed against the sponsoring institution during the past 24-month period? If yes, explain: Application for Programmatic Accreditation Revised January 2015 Yes No No 11. Complete the table below for each credential level program. DISCLOSURE: Only those program(s) listed on this application can be considered in the accreditation process. If the institution starts any other program(s) or revises any of the program(s) listed on this application after the on-site evaluation visit, and prior to a grant of accreditation being awarded, then a grant will not be awarded pending review and Commission consideration of the new/revised program(s). Credential Identify the # of awarded by credits offered for institution upon Number of each program program Instructional CHECK ONE completion Weeks per day (D), Example: Quarter Semester evening (E), & Diploma, weekend (W), if In Certificate, or Program Title applicable Class Total Type of Degree (As approved by oversight Example: Clock Outside Clock (Do not use agency(ies) listed in question #6) 40-D, 50-E, 60-W Hours Class Hours Hours abbreviations) NOTE: This field is not applicable to all programs. Institutions awarding credit for outside class hours will be required to provide a copy of the approval by the applicable oversight agency(ies) and include a detailed analysis of how these hours were derived, how they complement the given coursework, and how student’s benefit from the respective assignments. INITIAL APPLICANTS ONLY: Complete the table below for each credential level program. Program Title (As approved by oversight agency(ies) listed in question #7) Date of first class start # of students who started in the program during the past 24 months Current program enrollment # of graduates during the past 24 months Date of last graduating class INITIAL APPLICANTS ONLY: If there have been no graduates in the program(s) listed above, identify month and year when students will have completed at least 50% of the program(s) or 25% of the core coursework, including the date when students are to start clinical/externship. Program Title (As approved by oversight agency(ies) listed in question #6) Application for Programmatic Accreditation Revised January 2015 Date when students are anticipated to complete 50% of the program or 25% of the core coursework Date when students are to start clinical/externship 12. If any portion of a program(s) is offered via distance education, complete the table below: Per the Glossary of the Accreditation Manual, distance education is defined below: Distance Education (Distance Learning) - A formal educational process that uses one or more of the following technologies listed below (1-4) to deliver instruction to students who are separated from the instructor and to support regular and substantive interaction between students and the instructor, either synchronously or asynchronously. (1) the internet; (2) one-way and two-way transmissions through open broadcast, closed circuit, cable, microwave, broadband lines, fiber optics, satellite, or wireless communications devices; (3) audio conferencing; or (4) video cassettes, DVDs, and CD-Roms used in a course in conjunction with any of the technologies listed in 1 through 3. Distance Education - (Blended) - Incorporation of both traditional on-campus and distance learning within a course (sometimes called hybrid course) or program of study (sometimes called hybrid program). Distance Education - (Full) - All coursework within a program is delivered via distance education. Even if a program has an onground laboratory, clinical or externship experience for its students at remote locations, the program is defined by ABHES as a complete distance education program. If any portion of the program is delivered on the institution’s campus, the program would be defined as “blended.” (Students, please note that a distance education program may require an on-ground component at an offcampus facility, such as an externship at a hospital.) Program Title (As approved by oversight agency(ies) listed in question #6) 13. Credential awarded by institution upon program completion Types of Courses [e.g., general education, core, remote lab/externship/clinical] *Blended and/or Full Distance Education Delivery Has a representative from the program attended an ABHES Accreditation Workshop within the past 12 months? (See Chapter III of the Accreditation Manual for details regarding attendance requirements for the Accreditation Workshop). Yes No If yes, identify participants in the table below: Attendee Name 14. Title Campus (City & State) Workshop Date Attended Attestation and Signature The information and data submitted in this application are correct and current to the best of my knowledge. I adhere to the ABHES Bylaws contained in the ABHES Accreditation Manual: Administrator’s [Original] Signature: Application for Programmatic Accreditation Revised January 2015 Date: INITIAL APPLICANTS ONLY SUBMISSION INSTRUCTIONS ATTENTION NEW/INITIAL APPLICANTS: If applying for a new/initial grant of accreditation, the following must accompany the completed Application for Accreditation: A current school catalog; Signed (with original signature) Ownership Disclosure Form; Signed (with original signature) Attestation of Responsibility; and Application fee payment. Payment must be in the form of a check made payable to ABHES. Visit the ABHES website to view the current Fee Schedule in Appendix H/Fees of the Accreditation Manual, 17th Edition Effective 1/1/2012; Updated 1/5/2015 at http://www.abhes.org/accreditationmanual. A separate fee and completion of a separate Application for Accreditation is required for each program for which programmatic accreditation is being sought (e.g., Medical Assistant, Medical Laboratory Technology, and/or Surgical Technology). ABHES prefers that ALL APPLICANTS submit a completed application packet electronically via e-mail to applications@abhes.org. This may require documents to be professionally scanned as a JPG, TIF, MicrosoftCompatible, or ADOBE PDF to ensure that all information is legible and organized for ease of an electronic review. If the documents are scanned in per page and consist of more than two pages, please combine them into one document. All documents must include the original signatures where applicable. Application packets may also be submitted on a USB drive or CD Rom (mailed to the address below). When saving required documents, a separate document should be made and appropriately labeled and formatted as described above. The total number of attachments (if e-mailed) or files (if using a USB drive or CD Rom) is dependent on the application plus the number of exhibits to accompany the application. Each attachment/file should be named according to its content (e.g., “Completed Application”, “Ownership Disclosure Form”, “Catalog”, etc.). It is imperative that the application submission is properly labeled with the (1) institution’s name, (2) city/state, (3) Titled “APPLICATION FOR ACCREDITATION”, and (4) the Date of submission. The only hardcopy document required is a cover letter of intent and the application payment in the form of a check made payable to ABHES and mailed to the address below. ABHES 7777 Leesburg Pike, Suite 314N Falls Church, Virginia 22043 If you have any questions regarding the application, please call us at 703-917-9503. Application for Programmatic Accreditation Revised January 2015