APPLICATION FOR FINANCIAL CERTIFICATION BY THE OSA
REPRESENTATIONS OF OWNERSHIP & MANAGEMENT
I hereby affirm that I am an owner, director, or authorized agent of the institution named below, and that the
attached documents have been prepared by management from the records of the institution. To the best of my
knowledge and belief, they are true, correct, and complete. I understand that the financial statements and
supporting documentation submitted on behalf of the school are for a confidential investigation by the Office
of the State Auditor, and will be used to evaluate the school’s current solvency and continued financial eligibility
to offer non-degree-granting, career-oriented training programs in Massachusetts in accordance with Chapter
112, Section 263, of the General Laws.
I
certify that any and all public funds received by my school have been obligated and expended in accordance
with the provisions for which such funds were appropriated or otherwise authorized; and that the school is
currently maintaining effective controls over revenues, expenditures, assets and liabilities.
I certify that I have no knowledge of fraud or suspected fraud involving management or employees involved in
maintaining internal control that could have an adverse effect on the operations and activities of the school.
I
certify that there have been no communications from regulatory, accrediting, oversight agencies or auditors
regarding noncompliance or deficiencies in practices that could have an adverse effect on the overall financial
viability of the school.
I certify that this institution has not filed for bankruptcy during the past five years, nor has it been managed
by or otherwise under the control of a person that has filed for bankruptcy associated with the operation of
another educational institution during the past five years.
I
certify that no owner or manager of this institution has been convicted of or pled no contest or guilty to a
crime involving abuse of public funds, nor has any owner or manager of this institution controlled or managed
another institution that has ceased operation during the past five years without providing for the completion
of its programs by its students.
I
certify that no event has occurred or matters been discovered since the last fiscal year-end reporting date that
would render the school’s financial statements misleading and/or inaccurate.
Name of Institution: ___________________________________________________________________
Name of Owner/Authorized Agent: Title:
Signature: Date:
The Commonwealth of Massachusetts
AUDITOR OF THE COMMONWEALTH
ONE WINTER STREET, 9
th
FLOOR
BOSTON, MASSACHUSETTS 02108
AUDITOR
TEL (857) 242-5503
