Application For Approval To Participate In Federal Student Financial Aid Programs

OMB No. 1845-0012 Form Approved Exp. Date: 01/31/2020 Section A Section A. 1. Please answer these general questions. Tell us why you are submitting this application. (You may check more than one box.) Initial Certification. This is a request for initial approval to participate in federal student financial aid programs and to be initially designated as an eligible institution for other Higher Education Amendments (HEA) programs. Change in institutional ownership or structure. This is a request to participate in federal student financial aid programs and to be designated as an eligible institution for other HEA programs following a change in institutional ownership or structure. Check here if requesting a preacquistion review. Recertification. This is a request to continue to participate in federal student financial aid programs and to continue to be designated as an eligible institution for other HEA programs either in response to a recertification notice from us or because your institution's Program Participation Agreement (PPA) will expire soon. Designation as an eligible institution. This is a request to be designated as an eligible institution so that your students may receive deferments under federal student loan programs or so that your institution may apply to participate in federal HEA programs other than Title IV student financial aid programs, including the Hope and Lifetime Learning Tax Credits. Reinstatement. This is a request to be reinstated to participate in federal student financial aid programs and/or to be redesignated as an eligible institution for other HEA programs. Update Information. The purpose of this application is to update information about the institution. If you check "Update Information," please identify at least one purpose. Other (specify) 2. What is the name of your institution? 1 American LegalNet, Inc. www.FormsWorkFlow.com Section A 3a. Do you have another name such as a trade name or a d/b/a name, under which you legally do business as a postsecondary educational institution? Yes If yes, what is that name? No 3b. During the last 4 years, have you had another name that you have not previously reported to the Department of Education? Yes If yes, what is that name? No 4. Check here if you are an institution resulting from a merger in the past four years that you have not previously reported to the Department of Education, and give the names, TIN Numbers, and OPE ID numbers of the former (pre-merger) institutions. (You must enter the merger date in Question 19 (Section C)). OPE ID Name TIN 5. What is your 8 digit OPE ID Number? (Enter the first 6 digits. The final 2 digits are entered for you.) Check here if you are an initial applicant and do not have an OPE ID number, and go to Question 6. Current OPE ID (or former OPE ID if seeking reinstatement) 2 American LegalNet, Inc. www.FormsWorkFlow.com Section A 6a. What is your 9-digit Tax Identification Number (TIN) assigned by the IRS? 6b. What is your 9-digit DUNS number? 7. What was your most recently completed award year? Beginning date: Ending date: 07/01/____ 06/30/____ 8. What is your current award year? Beginning date: Ending date: 07/ 01/____ 06/30/____ 9. (Optional) Does your institution have a website (or home page) on the Internet? Yes If yes, list the electronic address (URL). No 10. Who is your chief executive officer (CEO)/president/chancellor? First name, MI, Last name, Suffix (include prefix, such as Mr., Ms., Dr.) Job Title Business street address City 3 American LegalNet, Inc. www.FormsWorkFlow.com Section A State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.) Telephone number (including area code) ext: Fax number (including area code) ext: E-mail address 11. Who is your chief fiscal officer/financial officer? First name, MI, Last name, Suffix (include prefix, such as Mr., Ms., Dr.) Job Title Business street address City State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.) Telephone number (including area code) ext: Fax number (including area code) ext: 4 American LegalNet, Inc. www.FormsWorkFlow.com Section A E-mail address 12. Who is your chief financial aid director? NOTE: This must be a capable individual designated to be responsible for administering all the Title IV, HEA programs and coordinating those programs with the institution's other Federal and non-Federal programs of student financial assistance. (See 34 CFR 668.16) First name, MI, Last name, Suffix (include prefix, such as Mr., Ms., Dr.) Job Title Business street address City State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.) Telephone number (including area code) ext: Fax number (including area code) ext: E-mail address 5 American LegalNet, Inc. www.FormsWorkFlow.com Section A 13. To whom do you wish us to send publications (such as the FSA Handbook) and printed communications concerning federal student financial aid? Check here if this is the same person as in Question 10. Check here if this is the same person as in Question 12. If neither of these people, complete the information below. First name, MI, Last name, Suffix (include prefix, such as Mr., Ms., Dr.) Job Title Mailing address City State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.) Telephone number (including area code) ext: Fax number (including area code) ext: E-mail address 6 American LegalNet, Inc. www.FormsWorkFlow.com Section A 14. Whom should we contact if we have questions about information in this form? (Note: If there is someone you wish us to contact outside of your institution, you may enter them in question 70.) Check here if this is the same person as in Question 10. Check here if this is the same person as in Question 12. If neither of these people, complete the information below. First name, MI, Last name, Suffix (include prefix, such as Mr., Ms., Dr.) Job Title Business street address City State and Zip+4 (or Foreign Province, Postal Code, and Country, if outside the U.S.) Telephone number (including area code) ext: Fax number (including area code) ext: E-mail address 7 American LegalNet, Inc. www.FormsWorkFlow.com Section B Section B. Please tell us about your accreditation and state authorization to provide postsecondary education. Check here if you are a foreign institution (including foreign graduate medical schools), and go to Section C. 15. What is your accrediting agency? If you have institution