22-10288A Non-College Degree Organization - Program Submission Lis

NON-INSTITUTION OF HIGHER LEARNING PROGRAM SUBMISSION LISTS
INSTRUCTIONS
When completing VA Form 22-10288a, Program Submission List, please only complete the section related to the type of training provided by your facility, leaving the pages with
different types of training blank. Please complete Part I and Part II below in their entirety.
Please Note: This form must be submitted with VA Form 22-10288, Application for Approval of a Non-College Degree, Vocational Flight School, License/Certification Exam,
Preparatory Courses for License/Certification, Correspondence School, High School, Apprenticeship/On-the-Job Training or Multi-State Apprenticeship Facility.
After completing the Application and Program Submission List, please email the documents to the State Approving Agency (SAA) of jurisdiction for their review. Please use this link:
https://nasaa-vetseducation.com/nasaa-contacts/ to locate the SAA with jurisdiction over your facility (or facilities).

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 [email protected]. Please refer to OMB Control No. 2900-0932 in any correspondence. Do not send your
completed VA Form 22-10288a to this email address.

VA FORM 22-10288a, XXXX

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OMB Control No. 2900-0932
Respondent Burden: 1 Hour
Expiration Date: XXXX

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
XXXX

22-

22-10288a

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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VOCATIONAL FLIGHT SCHOOL - PROGRAM SUBMISSION LIST
1. INSTITUTION NAME

2. FACILITY CODE

3. CATALOG PUBLICATIONS USED IN THIS FORM
1)
2)
3)
SUBMITTED VOCATIONAL FLIGHT PROGRAMS FOR EVALUATION OF APPROVAL

PROGRAM NAME

COURSE

AWARD/DEGREE

PART 141 OR
142
APPROVED

CATALOG
PUBLICATION
NUMBER (As

Listed Above)

CIP CODE

HOURS

TUITION

NOTES

PAGE
NUMBER
PROGRAM
LISTED

COURSE
HOURS

HOURLY RATE

LINE-ITEM COST

$
$
$
$
$
REMARKS

This is page

of

with programs submitted for approval.
SAA ONLY - REMARKS

SAA USE ONLY Approve (Y/N)

VA FORM 22-10288a, XXXX

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VOCATIONAL FLIGHT SCHOOL - ADDITIONAL INFORMATION SUBMISSION LIST
1. INSTITUTION NAME

2. FACILITY CODE

AIRCRAFT/FLIGHT SIMULATORS/FLIGHT TRAINING DEVICES

AIRCRAFT/SIM/FTD

FAA REGISTRATION

HORSEPOWER

CIP CODE

HOURS

TUITION

NOTES

Please fill-out a new copy of this page for any additional Aircraft you would like to have approved for VA Education Benefits.
AIRCRAFT USED FOR EACH PROGRAM
AIRCRAFT/SIM/FTD

PROGRAM

AIRCRAFT/SIM/FTP

PROGRAM

Please fill-out a new copy of this page for any additional Aircraft you would like to have approved for VA Education Benefits.
ROSTER OF ADMINISTRATIVE AND INSTRUCTIONAL STAFF
AIRCRAFT/SIM/FTD

PROGRAM

AIRCRAFT/SIM/FTP

PROGRAM

Please fill-out a new copy of this page for any additional Administrative/Instructional Staff.
VA FORM 22-10288a, XXXX

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VOCATIONAL FLIGHT SCHOOL - ADDITIONAL INFORMATION SUBMISSION LIST (Continued)
REMARKS

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VA FORM 22-10288a, XXXX

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LICENSE/CERTIFICATION EXAM ORGANIZATION - EXAMINATION SUBMISSION LIST
1. INSTITUTION NAME

2. FACILITY CODE

3. PUBLICATIONS USED IN THIS FORM
1)
2)

3)
SUBMITTED EXAMS FOR EVALUATION OF APPROVAL

License or Certification Information Section
License or Certification (L/C):

License

Certification

CIP Code

Date Valid:
L/C Abbreviation:

Name of License or Certification:
Prerequisite education or training
needed to obtain the L/C:

Length of time L/C is valid:
Entities that recognize the L/C:
Requirements for maintaining or renewing the L/C:

Exam(s) License or Certification Information Section
Name of exam(s) seeking reimbursement:

Exam(s) name Abbreviation:

Maximum fee charged for exam (Only exam related fees may be reimbursed): $
Description of exam(s) including purpose:
Requirements to take the exam(s):
Length of time before results are released:
Description of exam(s) including purpose:
REMARKS

Please fill-out a new copy of this page for any additional License/Certification and Exams you would like to have approved for VA Education Benefits.
This is page

of

SAA USE ONLY Approve (Y/N)
VA FORM 22-10288a, XXXX

with programs submitted for approval.
SAA ONLY - REMARKS

Page 6

PREPARATORY COURSE FOR LICENSE/CERTIFICATION EXAM ORGANIZATION - PROGRAM SUBMISSION LIST
1. INSTITUTION NAME

2. FACILITY CODE

3. CATALOG PUBLICATIONS USED IN THIS FORM
1)
2)
3)
SUBMITTED PREPARATORY PROGRAMS FOR EVALUATION OF APPROVAL

Preparatory Course Approval Section
Entities that recognize the L/C:

Course tuition cost:

Are there any mandatory course fees? (Fees can include instructional materials only if these are mandatory resources for the program.)

Yes

$

No

List of course fees (Please attach additional information if more space is needed. The SAA may request additional information if required.):

Total Course Tuition and Fees Eligible for Reimbursement:

$

Test prep courses may be offered online or in an online/in-person hybrid modality in accordance with the facility's approval. There is no monetary cap for these courses, as the costs of these courses are
charged to entitlement pursuant to 38 U.S.C. § 3315B.
VA beneficiaries may repeat these courses as many times as they deem appropriate as beneficiaries do not receive housing allowance for these courses, but using more entitlement if they chose to take
the course repeatedly. Therefore, no waiting period is necessary, and a VA beneficiary may repeat from the same or a different course provider.
License or Certification Exam Information Section
For educational assistance to be payable for a licensing, certification, or national exam preparatory course, the exam for which the course is designed mus already be approved under 38 CFR § 21.4268(b).
Name of exam(s) the course prepares for:
Does the exam certify for License or Certification?

License

Certification

CIP Code

Name of L/C the exam(s) certify for:

Name of the organization that issues the L/C:
Entities that recognize the License or Certification:

VA FORM 22-10288a, XXXX

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PREPARATORY COURSE FOR LICENSE/CERTIFICATION EXAM ORGANIZATION - PROGRAM SUBMISSION LIST (Continued)
REMARKS

Please fill-out a new copy of this page for any additional Preparatory Courses you would like to have approved for VA Education Benefits.
This is page

of

with programs submitted for approval.
SAA ONLY - REMARKS

SAA USE ONLY Approve (Y/N)

VA FORM 22-10288a, XXXX

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CORRESPONDENCE SCHOOL / COURSES - 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 CORRESPONDENCE PROGRAMS FOR EVALUATION OF APPROVAL

PROGRAM NAME

AWARD/
DEGREE

CATALOG
PUBLICATION
NUMBER

(As Listed
Above)

PAGE
NUMBER
PROGRAM
LISTED

IN THE PAST
SIX MONTHS,
HAVE 50% OF
THOSE
PURSUING THE
COURSE
COMPLETED IT
WITHIN SIX
MONTHS? (Y/N)

CIP CODE

NOTES

SAA USE
ONLY
Approve (Y/N)

REMARKS

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VA FORM 22-10288a, XXXX

with programs submitted for approval.
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HIGH SCHOOL - 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 HIGH SCHOOL DIPLOMA PROGRAMS FOR EVALUATION OF APPROVAL

PROGRAM NAME

AWARD/
DEGREE

CATALOG
PUBLICATION
NUMBER

(As Listed
Above)

PAGE
NUMBER
PROGRAM
LISTED

CREDITS/
CLOCK
CIP CODE
HOURS FOR
GRADUATION

NOTES

SAA USE
ONLY
Approve
(Y/N)

REMARKS

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VA FORM 22-10288a, XXXX

with programs submitted for approval.
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APPRENTICESHIP, ON-THE-JOB TRAINING, OR MULTI-STATE REGISTERED APPRENTICESHIP - TRAINING PROGRAM SUBMISSION LIST
1. INSTITUTION NAME

2. FACILITY CODE

Please provide a schedule listing various operations for major kinds of work or tasks to be learned and showing for each job operations or work, tasks to be performed, and the approximate length of time to be spent on each operation
or task; and the complete standards of apprenticeship/or training agreement including any appendices.
SUBMITTED OCCUPATIONS FOR EVALUATION OF APPROVAL
3. JOB TITLE (Position for which training will be provided)

4. JOB DESCRIPTION (Please keep brief)

5. LENGTH OF PROGRM (Indicate hours or months)

6. HOURS IN STANDARD WORK WEEK

7. HOURS OF RELATED TRAINING OUTSIDE OF JOB
REQUIRED EACH YEAR (If non, write "None")

8. NUMBER OF FULLY QUALIFIED EMPLOYEES
AVAILABLE AS INSTRUCTORS FOR EACH TRAINEE

9A. MAXIMUM NUMBER OF TRAINEES THAT CAN BE TRAINED AT ANY ONE TIME

9B. CIP CODE

10. BEGINNING WAGE FOR TRAINEES

11. PRESENT JOURNEYWORKER WAGE

12. WAGE PROGRESSION DURING TRAINING
A. PERIOD

B. NO. OF MONTHS

C. WAGE LEVEL

A. PERIOD

B. NO. OF MONTHS

C. WAGE LEVEL

1ST

$

PER

6TH

$

PER

2ND

$

PER

7TH

$

PER

3RD

$

PER

8TH

$

PER

4TH

$

PER

9TH

$

PER

5TH

$

PER

10TH

$

PER

Please fill-out a new copy of this page for any additional Preparatory Courses you would like to have approved for VA Education Benefits.
This is page

of

with programs submitted for approval.
SAA ONLY - REMARKS

SAA USE ONLY Approve (Y/N)

VA FORM 22-10288a, XXXX

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