Fill - Free fillable Application OSA (Commonwealth of Massachusetts) PDF form

MASSACHUSETTS PRIVATE OCCUPATIONAL SCHOOL LICENSURE PROGRAM

APPLICATION FOR PRIVATE OCCUPATIONAL SCHOOL FINANCIAL CERTIFICATION

(TO BE COMPLETED BY SCHOOL OWNER/ DIRECTOR/ AUTHORIZED REPRESENTATIVE)

apter 112, Section 263 of the General Laws requires the Office of the State Auditor (OSA) to investigate the

ownership, organization, and financial condition of each person or entity licensed or applying to the Division

of Professional Licensure (DPL) for an original license to offer non-degree-granting, career-oriented training

programs in Massachusetts; to ensure that the Enrollment Agreements used by for-profit private occupational

schools in MA contain the pro rata refund provisions required by Chapter 255, Section 13K, of the General

Laws; to annually establish the level of indemnification/surety protection needed by each school to cover

potential refunds payable to students, based on the school’s maximum projected unearned tuition income; and

to report the results of each investigation to the DPL Office of Private Occupational School Education.

me of School: _______________________________________________________________________________

Address of Main Campus: _______________________________________________________________________

Website: _____________________________________________________________________________________

School Owner/Chief Executive Officer: __________________________Title: _____________________________

Telephone: _____________________ Cell Phone: ________________ Email: _____________________________

School Director/ Contact Person: _______________________________Title: _____________________________

Telephone: _____________________ Cell Phone: _________________Email: ____________________________

Date Established/ State: ________________________________________/________________________________

Year Initially Licensed to Offer Occupational Training Programs in MA: _______________________________

MA DPL Private Occupational School License Number: ______________________________________________

MA DPL License Period: _______________________________________________________________________

School Fiscal Year End Date: ____________________________________________________________________

Current School Indemnification/Surety Protection Level: ____________________________________________

Actual MA Occupational School Tuition Income/ Enrollment Last Year: $__________________/__________

Projected MA Occupational School Tuition Income/ Enrollment Next Year: $__________________/__________

The Commonwealth of Massachusetts

AUDITOR OF THE COMMONWEALTH

ONE WINTER STREET 9

FLOOR

BOSTON, MASSACHUSETTS 02108

SUZANNE M. BUMP, ESQ.

AUDITOR

TEL (857) 242-5503

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APPLICATION FOR PRIVATE OCCUPATIONAL SCHOOL FINANCIAL CERTIFICATION

I. NATURE OF BUSINESS: OWNERSHIP, ORGANIZATION & CONTROL

Yes

N/A

Details/ Further Explanation

Is the Massachusetts occupational school a

private entity that maintains a place of business

within the Commonwealth or solicits business

within the Commonwealth to provide classroom

instruction, distance education, or both? (MGL

Chapter 112, Section 263, Subsection a)

Is the Massachusetts school a private educational

organization not specifically exempted by MGL

Chapter 112, Section 263 (c) that conducts

courses for profit or by charging tuition for the

purpose of training or preparing students for a

business, trade, technical, or industrial

occupation, or any other vocational purpose,

including private correspondence schools,

business schools, trade schools, or similar

entities designated by the Division of

Professional Licensure? (MGL Chapter 112,

Section 263, Subsection b)

Is the applicant a school, college, or educational

institution chartered and authorized by the

Commonwealth of Massachusetts

to grant

degrees? (Per MGL Chapter 112, Section 263 (c)-

Exempt)

Is the applicant a school conducted by a person or

entity for the education and training of such

person or entity’s employees, with no fee or

tuition charged to the employee? (Per MGL

Chapter 112, Section 263 (c)- Exempt)

Is the applicant a school providing distance

learning or online correspondence services having

no place of business within the Commonwealth?

(Per MGL Chapter 112, Section 263 (c)- Exempt)

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APPLICATION FOR PRIVATE OCCUPATIONAL SCHOOL FINANCIAL CERTIFICATION

I. NATURE OF BUSINESS: OWNERSHIP, ORGANIZATION & CONTROL (CONTINUED)

Yes

Details/ Further Explanation

Is the institution offering training exclusively for

the purpose of recreation or other non-career-

related pastimes? (Per MGL Chapter 112, Section

263 (c)- Exempt)

Is the applicant a private school owned and

operated by an established religious institution for

the purpose of providing religious instruction?

(Per MGL Chapter 112, Section 263 (c)- Exempt)

Is the applicant a public school district or

combination of school districts? (Per MGL

Chapter 112, Section 263 (c)- Exempt)

Does the applicant provide programs for the

education of students in grades pre-kindergarten

through twelve? (Per MGL Chapter 112, Section

263 (c)- Exempt)

Does the applicant offer incidental training

associated with the purchase of a product from a

vendor, provided that the training is to familiarize

the purchaser with the use of the product and the

purchaser is not awarded any form of a certificate

or diploma for having received the training? (Per

MGL Chapter 112, Section 263 (c)- Exempt)

If incorporated, has documentation been

submitted to the OSA with documentation

pertaining to the corporation’s Articles of

Organization and most recent Annual Report

filed with the Secretary of the Commonwealth of

Massachusetts, Corporations Division?

If organized as a partnership, has the school

provided the OSA with a copy of its Partnership

Agreement listing the name and title of each

partner and each partner’s percentage of

controlling interest?

If organized as a sole proprietorship, has the

school provided the OSA with copies of the

Business Certificates filed with the respective

City or Town Clerks for each location?

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APPLICATION FOR PRIVATE OCCUPATIONAL SCHOOL FINANCIAL CERTIFICATION

I. NATURE OF BUSINESS: OWNERSHIP, ORGANIZATION & CONTROL (CONTINUED)

Yes

N/A

Details/ Further Explanation

If organized as a non-profit tax-exempt entity,

has a copy of the IRS Exemption/ 501 (c) (3)

Determination Letter been presented to the OSA?

Is the school authorized by the Department of

Veterans Affairs to offer training programs to

Veterans under the Post 9/11 GI Bill?

Is the school authorized by the U.S. Department

of Education to participate in federal Title IV

student financial assistance programs?

Is the school accredited by a U.S. Department of

Education-approved accrediting agency? (Please

identify accreditor & accreditation period.)

Has the applicant been denied accreditation,

removed from accreditation, or voluntarily

withdrawn its accreditation from an accrediting

agency?

Is the MA school corporately affiliated with any

other schools? (Please identify school affiliates.)

Is the school currently licensed or authorized to

offer postsecondary occupational training

programs in any other state? (Please identify

other states)

Are there currently any pending administrative or

legal actions being taken against the school by

the U. S. Department of Education, other federal

or state oversight agencies, or any nationally-

recognized accrediting agencies?

Have any school owners or officials been

directly or indirectly employed or affiliated with

any school which has lost or been denied

licensure by any state agency during that

individual’s period of employment?

Have any school owners or officials been

directly or indirectly employed or affiliated with

any school which has closed or entered into

bankruptcy during that individual’s period of

employment or affiliation?

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APPLICATION FOR PRIVATE OCCUPATIONAL SCHOOL FINANCIAL CERTIFICATION

I. NATURE OF BUSINESS: OWNERSHIP, ORGANIZATION & CONTROL (CONTINUED)

Yes

N/A

Details/ Further Explanation

Has the school owner, director, or any

corporation, partnership, association, or person

holding an ownership or control interest in this

school, or any employee responsible in a

supervisory capacity for the administration of

student funds or government funds, been

convicted of a crime involving the operation of

any educational or training program, or, in

connection with the operation of any such

program, a crime involving the unlawful

acquisition, use, or expenditure of educational or

training program funds?

Is any action pending (e.g. court action, audit,

inquiry, review, administrative action), or has

action been taken, by any court or administrative

body (federal or state court, grand jury, special

investigator, U.S. Department of Education, or

state agency) as to any owner or manager, or any

school with which an owner or manager has been

directly or indirectly employed or affiliated, in a

civil or criminal forum that is not otherwise

disclosed in this application?

- 6 -

APPLICATION FOR PRIVATE OCCUPATIONAL SCHOOL FINANCIAL CERTIFICATION

II. COMPLIANCE WITH OSA STANDARDS OF FINANCIAL RESPONSIBILITY

Yes

N/A

Details/ Further Explanation

Have comparative year-end financial

statements been submitted to the OSA

on behalf of the applicant to demonstrate

a record of responsible financial

management, with resources sufficient

to ensure the continued operation of the

school and the completion of training for

all enrolled participants?

Were the financial statements prepared

on an accrual basis by an independent

public accountant in accordance with

generally accepted accounting principles

(GAAP)?

Does the Independent Auditor’s Report

state whether the financial statements

are presented fairly, in all material

respects, in accordance with accounting

principles generally accepted in the

United States of America?

Did the independent public accountant

express an adverse, disclaimed, or

qualified opinion on the school’s

financial statements?

Did the independent public accountant

express doubt about the institution’s

ability to continue as a going concern?

If the opinion expressed on the

Independent Auditor’s Report was

modified, does the report include a

paragraph describing the Basis for

Qualified Opinion or Basis for Adverse

Opinion, as appropriate?

Did the Independent Auditor’s Report

include an “Other Matters” section that

disclosed required supplementary

information such as a Management’s

Discussion and Analysis (MD & A)

narrative? (Please attach)

- 7 -

APPLICATION FOR PRIVATE OCCUPATIONAL SCHOOL FINANCIAL CERTIFICATION

II. COMPLIANCE WITH OSA STANDARDS OF FINANCIAL RESPONSIBILITY (CONTINUED)

Yes

N/A

Details/ Further Explanation

Has a bank statement or the equivalent

documentation been submitted to the

OSA to verify the level of resources

available to the school at fiscal year-end

(consistent with the level of cash, cash

equivalents, and temporary investments

reported on the school’s year-end

financial statements)?

Has an updated bank statement or the

equivalent documentation been

submitted to the OSA to verify the

current level of resources available to

the Massachusetts school?

If the organization is applying to the

DPL for an original license to operate a

private occupational school in MA, has

the school projected its anticipated total

revenue, expenses, and end-of-year

balances for the first full 12 month

period of operations (regardless of the

fiscal year end date)?

Have the records pertaining to the

school’s accounts and activities been

maintained separately from the personal

finances of the owner (s) and from other

business activities of the owner(s)?

Has the Massachusetts school reported

positive net income for the most recent

fiscal year, or for at least two of the

three most recent fiscal years?

Has the Massachusetts school

experienced material increases or

decreases in total revenue and/or

expenses for the most recent year?

Has the Massachusetts school

maintained a current ratio of at least 1.0

to 1.0 (current assets / current liabilities)

at fiscal year-end?

- 8 -

APPLICATION FOR PRIVATE OCCUPATIONAL SCHOOL FINANCIAL CERTIFICATION

II. COMPLIANCE WITH OSA STANDARDS OF FINANCIAL RESPONSIBILITY (CONTINUED)

Yes

N/A

Details/ Further Explanation

If the Massachusetts school is a wholly-

owned subsidiary and/or financially

dependent upon a parent corporation or

third-party entity, has the parent entity

submitted consolidated audited financial

statements to the OSA?

Do the parent corporation’s consolidated

financial statements include a

breakdown of total revenue, expenses,

and net income per operating segment?

Has the organization as a whole reported

positive net income for the most recent

year, or for two of the three most recent

fiscal years?

Has the organization as a whole

experienced material increases or

decreases in total revenue and /or

expenses for the latest fiscal year?

Has the organization as a whole

maintained a current ratio of at least 1.0

to 1.0 (current assets / current liabilities)

at fiscal year-end?

Has the organization as a whole reported

positive tangible net worth for the most

recent fiscal year, or for two of the three

most recent fiscal years?

Has the Massachusetts school reported

positive tangible net worth for the latest

fiscal year, or for two of the three most

recent fiscal years?

- 9 -

APPLICATION FOR PRIVATE OCCUPATIONAL SCHOOL FINANCIAL CERTIFICATION

III. FEDERAL STANDARDS OF FINANCIAL RESPONSIBILITY FOR HIGHER EDUCATION INSTITUTIONS

(US DEPARTMENT OF EDUCATION// TITLE IV - APPROVED SCHOOLS ONLY)

U.S. DEPARTMENT OF EDUCATION OPE ID: ____________________________________________________________

NUMBER OF CAMPUSES INCLUDED IN OPE ID ABOVE: __________________________________________________

LOCATION(S) OF ADDITIONAL CAMPUSES INCLUDED IN OPE ID: ABOVE: _______________________________

________________________________________________________________________________________________________

Yes

N/A

Details/ Further Explanation

Did the Massachusetts school’s

overall Composite Score

for the

most recent fiscal year, (based on its

Primary Reserve, Equity, and Net

Income ratios) meet the approval

standard of 1.5 (on a scale of -1 to

+3.0) established by the U.S

Dep

artment of Education? (Pleas

identify latest composite score/

fiscal period.)

Did the financial information

reported on behalf of the

Massachusetts

school to the DOE

under its OPE ID include

consolidated data

reported on

behalf of other private educational

institutions having no place of

business in Massachusetts?

Was the MA school in compliance

with the Title IV/ HEA 90/10 Rule

last year limiting the school’s

federal student financial assistance

funds to no more than 90% of the

school’s total eligible cash receipts?

(Please identify percentage and

dollar amount received)

Did the default rate on Title IV

loans for attendees of the MA

school

exceed 40% for any one

cohort (year) or 30% for three

consecutive cohorts?

If the U.S. Department of Education

is allowing the school to continue to

participate in Title IV programs

under a Provisional Certification,

has the school detailed the terms

and conditions of the Provisional

Certification to the OSA?

- 10 -

APPLICATION FOR PRIVATE OCCUPATIONAL SCHOOL FINANCIAL CERTIFICATION

IV. CALCULATION OF MASSACHUSETTS PROJECTED UNEARNED TUITION INCOME/

POTENTIAL REFUNDS PAYABLE TO STUDENTS FOR THE UPCOMING YEAR

1. Total Students Enrolled in Massachusetts Occupational Training Program Last Year

(Identify Period):____________________________________________________

2. Total Tuition Income Generated by Massachusetts Occupational Training Programs

Last Year

______________________________________________________________

3. Total Revenue Generated by Massachusetts Occupational School as a Whole Last

Year: ________________________________________________________________

4. Percentage of MA Occupational School Tuition Income to Total Revenue Last Year:

5. Please Attach MA Private Occupational School Course Calendar for the Upcoming

Year.__________________________________________

6. Please Attach MA Student Enrollment Agreement Listing Tuition/Course & Payment

Options._____________________________________________________________

7. Please Identify the Anticipated MA Occupational School/Enrollment/Program for the

Upcoming

Year:____________________________________________________________

8. Please Project the Total Anticipated Enrollment/Program for the Upcoming Year.

___________________________________________________________________

9. Please Project the Anticipated Breakdown of Students & Income/Payment Plan for

the Upcoming Year.______________________________________________

(Prepayment in Full, Quarterly/Monthly/Weekly/Installments, Employer Payment

upon Completion, etc.)

10. Please Identify the Payment Terms and Conditions for Projected Government-

Subsidized Students This Year___________________________________________

11. Please Attach a Spreadsheet detailing the Anticipated MA Occupational School

Tuition Income and Enrollment per Month for the Upcoming Year.

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