VA FORM 22-10287a INSTITUTION OF HIGHER LEARNING - PROGRAM SUBMISSION LIST

OMB Control No. 2900-XXXX
Respondent Burden: 1 hour
Expiration Date: XXXXXXXX

INSTITUTION OF HIGHER LEARNING - 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 IHL/NCD PROGRAMS FOR EVALUATION OF APPROVAL

PROGRAM NAME

VA FORM
XXXXXXX

22-

22-10287a

AWARD/
DEGREE

CATALOG
PUBLICATION
NUMBER

(As Listed
Above)

PAGE
NUMBER
PROGRAM
LISTED

CREDITS/CLOCK
HOURS OF PROGRAM
(Non-Accredited, NCD or
Clock Hour Programs
Only)

CIP CODE

NOTES

SAA USE
ONLY
Approve (Y/N)

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INSTITUTION OF HIGHER LEARNING - PROGRAM SUBMISSION LIST (Continued)
REMARKS

This is page

VA FORM 22-10287a

of

with programs submitted for approval.

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NON-COLLEGE DEGREE ORGANIZATION - 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

AWARD/
DEGREE

CATALOG
PUBLICATION
NUMBER

(As Listed
Above)

PAGE
NUMBER
PROGRAM
LISTED

CREDITS/
CLOCK
HOURS OF
PROGRAM

NUMBER OF
THEORY vs
NUMBER OF
SHOP/
PRACTICE
CLOCK HOURS

CIP CODE

NOTES

SAA USE
ONLY
Approve (Y/N)

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NON-COLLEGE DEGREE ORGANIZATION - PROGRAM SUBMISSION LIST (Continued)
REMARKS

This is page

of

with programs submitted for approval.
PART I: INSTITUTION CONTACTS

4. NAME OF SCHOOL CERTIFYING OFFICIAL (Leave blank for original application)

5. 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.
6A. NAME OF AUTHORIZING OFFICIAL

6B. SIGNATURE OF AUTHORIZING OFFICIAL

6C. 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. Your obligation to respond is required to obtain or retain education benefits. The
requested information is considered relevant and necessary to determine the maximum benefits under the law. While you do not have to respond, VA cannot process your claim for education assistance unless the information is
furnished as required by existing law (38 U.S.C. 3471). The responses you submit are considered confidential (38 U.S.C. 5701). Any information provided by applicants, recipients, and others may be subject to verification
through computer matching programs with other agencies.
RESPONDENT BURDEN: We need this information to determine your continued eligibility to VA education benefits (38 U.S.C. 3471). Title 38, United States Code, allows us to ask for this information. We estimate that you
will need an average of 1 hour to review the instructions, find the information and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not
required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain.

VA FORM 22-10287a

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