22-10287A Institution of Higher Learning - Program Submission List

INSTITUTION OF HIGHER LEARNING - PROGRAM SUBMISSION LIST
SIGNATURE PAGE
PART I: INSTITUTION CONTACTS
NAME OF SCHOOL CERTIFYING OFFICIAL (Leave blank for original application)

SCHOOL CERTIFYING OFFICIAL EMAIL ADDRESS (Leave blank for original application)

PART II: CERTIFICATION AND SIGNATURE OF AUTHORIZING OFFICIAL
NOTE: ADDITIONAL DOCUMENTATION - The State Approving Agency and/or VA may require additional information or documentation to process a facility approval and meet applicable state or federal laws.
I CERTIFY THAT all statements in this application are true and correct to the best of my knowledge and belief.
NAME OF AUTHORIZING OFFICIAL

SIGNATURE OF AUTHORIZING OFFICIAL

DATE SIGNED (MM/DD/YYYY)

PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any sources other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations, Section
1.526 for routine uses (e.g. VA sends education forms or letters with a veteran's identifying information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for the VA
to obtain further information as may be necessary from the school for the VA to properly process the veteran's education claim or to monitor his or her progress during training as identified in the VA System of Records,
58VA21/22/28, Compensation, Pension, Education and Veteran Readiness and Employment Records - VA, published in the Federal Register.
RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number
for this project is 2900-0932 and it expires XX/XX/20XX. Public reporting burden for this collection of information is estimated to average 1 hour per respondent, per year, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate and any other aspect of this collection of
information, including suggestions for reducing the burden, to VA Reports Clearance Officer at VACOPaperworkReduAct@va.gov. Please refer to OMB Control No. 2900-0932 in any correspondence. Do not send your
completed VA Form 22-10287a to this email address.

VA FORM
XXXX

22-10287a

Page 1

OMB Approved No. 2900-0932
Respondent Burden: 1 Hour
Expiration Date: XXXXXXX

INSTITUTION OF HIGHER LEARNING - PROGRAM SUBMISSION LIST
INSTRUCTIONS: When completing VA Form 22-10287a, Program Submission List, please complete each section, as applicable for your facility. Please complete Part I and Part II below in their entirety.
NOTE: This form must be submitted with the VA Form 22-10287, Application for Approval of an Institution of Higher Learning Facility. After completing the Institution of Higher Learning - Program Submission List, please email
the documents to the State Approving Agency (SAA) of jurisdiction for their review. Please use the following link to locate the SAA with jurisdiction over your facility (or facilities):
https://nasaa-vetseducation.com/nasaa-contacts/.
1. INSTITUTION NAME

2. FACILITY CODE

3. CATALOG PUBLICATIONS USED IN THIS FORM (If your submission requires more than three catalog publications, please attach an additional copy of this form.)
1)
2)
3)

SUBMITTED IHL PROGRAMS FOR EVALUATION OF APPROVAL
PROGRAM NAME

VA FORM
XXXX

22-10287a

AWARD/
DEGREE

CATALOG
PUBLICATION
NUMBER (As

listed above)

PAGE
NUMBER
PROGAM
LISTED

CREDITS/CLOCK
HOURS OF PROGRAM

(Non-accredited or
Clock Hour Programs
Only)

SAA USE ONLY
CIP CODE

NOTES

APPROVE?

(Yes/No)

Page 2

REMARKS

This is page

of

VA FORM 22-10287a, XXXX

with programs submitted for approval.

Page 3

OMB Approved No. 2900-0932
Respondent Burden: 1 hour
Expiration Date: 4/30/2024

NON-COLLEGE DEGREE - PROGRAM SUBMISSION LIST
1. INSTITUTION NAME

2. FACILITY CODE

3. CATALOG PUBLICATIONS USED IN THIS FORM (If your submission requires more than three catalog publications, please attach an additional copy of this form.)
1)
2)
3)

SUBMITTED NCD PROGRAMS FOR EVALUATION OF APPROVAL
PROGRAM NAME

VA FORM 22-10287a, XXXX

AWARD/
DEGREE

CATALOG
PUBLICATION
NUMBER (As

listed above)

PAGE
NUMBER
PROGAM
LISTED

CREDITS/CLOCK
HOURS OF PROGRAM

NUMBER OF
THEORY vs.
NUMBER OF
SHOP/
PRACTICE
CLOCK HOURS

SAA USE ONLY
CIP CODE

NOTES

APPROVE?

(Yes/No)

Page 4

REMARKS

This is page

of

VA FORM 22-10287a, XXXX

with programs submitted for approval.

Page 5