Colorado Report of Educational Service Offerings Other than the Approved Site

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					                                                                               SITE-1   Rev03.06.08


                             Division of Private Occupational Schools
                                    1560 Broadway, Suite 1600
                                     Denver, Colorado 80202



           REPORT OF EDUCATIONAL SERVICE OFFERINGS
                OTHER THAN THE APPROVED SITE

1. School Name: __________________________________________________________

2. Address: ______________________________________________________________
                ______________________________________________________________

3. Name of program/course: ________________________________________________

4. Opening date: ___________________                Ending date: ___________________

5. Length of course or other educational service: ____________ clock hours/credit hours

6. Number of students anticipated: _______________________

7. Location of facilities (complete address):
   ______________________________________________________________________
   ______________________________________________________________________
   ______________________________________________________________________


8. Describe facilities, square feet, etc.
   ______________________________________________________________________
   ______________________________________________________________________
   ______________________________________________________________________
   ______________________________________________________________________
   ______________________________________________________________________

   Submitted By:

   _______________________________________
   Printed Name of School Director/Owner

   _______________________________________                    _________________
   Signature of School Director/Owner                         Date



   Approved By:

   _______________________________________                    _________________
   DPOS Program Specialist                                    Date

				
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