OFFICE OF HIGHER EDUCATION

PROGRAM LICENSURE APPLICATION

Effective February 15, 2017

For use only by currently licensed institutions wishing to offer a new program

Submit as a Word document via email and as a print copy through the mail.

Applicant Institution: / Date:
Anticipated Initiation Date: / Duration of the program:
Name of Proposed Program:
Mode of delivery (on ground, online, or hybrid):
On ground: instruction is exclusively face-to-face (includes web-assisted courses).
Online: instruction is exclusively remote.
Hybrid: a combination of on ground, online, or hybrid courses.
*Web-assisted: a course management system or website is used to post and exchange materials and information.
Is the proposed program a degree or certificate program?
Title (and abbreviation):
Number of credits:
CIP Code No. (optional): / Title of CIP Code (optional):
Department where the program will be housed:
Institutional Contact Person: / Title: / Telephone:
Email:

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I. Accreditation

  1. Is your institution regionally or nationally accredited?
  1. If yes, provide the name of accrediting body.
  1. Provide the dates of the next comprehensive visit and the next interim report.
  1. Do you anticipate that the proposed program will be accredited by a professional organization or other outside accreditor? If so, name the accrediting body.
  1. Will this program provide eligibility for a state approved or other licensed profession? If so, identify.
  1. If yes, attach a copy of the agency’s licensing or certification requirements.

II. Program Description

1.  Please provide a brief description of the program.

2.  Describe the program content, stating how it relates to similar programs at your institution.

3.  Describe the careers and professions available to graduates of the program.

4.  Briefly describe how the program was developed. Please attach any internal documents (e.g., feasibility reports, department studies, etc.) that may provide greater clarification and support for the proposed program.

5.  Has an advisory board been consulted in the development of the program? If so, what is its make-up and how does it meet industry and workforce needs? If an advisory board is planned, please provide a timeline for its convening.

6.  Describe how the course development and sequencing support the degree level and address the stated objectives of the program.

7.  Briefly describe how the program will be assessed (internally and externally) and how often this assessment will occur.

III. Purpose and Objectives

  1. List the learning objectives of the proposed program, and briefly state how those objectives relate to the institutional mission.

IV. Administration

  1. Provide the name and qualifications of the full-time administrator or faculty member who will be responsible for the day-to-day operations of the program. Please list all administrative and teaching responsibilities, indicating whether this person will be responsible for any other programs at your institution. If this individual is still to be hired, indicate the timeframe for hiring and the desired qualifications.

V. Program Admissions and Special Requirements

  1. What are the admissions requirements for this program?
  1. Does this program have special graduation requirements (e.g., capstone or special project)? If so, please describe.
  1. Does this program require fieldwork (e.g., clinical affiliations, internships, externships, etc.)? If so, please describe and attach copies of the contracts or other documents ensuring program support.

VI. Enrollment

  1. Describe your prospective students for the program.
  1. Describe the academic or career backgrounds of students who might be interested in the program.
  1. Describe how you plan to market the program.

VII. Faculty

  1. Provide the number of new faculty (designate full-time, part-time and adjunct) to be hired for this program by year for the next 3 years.
  1. How many full-time faculty will teach in the program’s core curriculum?
  1. How many adjunct and part-time faculty will teach in the program’s core curriculum?

VIII. Resources

  1. Describe the library resources designated for the program.
  1. Describe the facilities and equipment allocated to the program (e.g., lab space designated for faculty and students, office furniture, classroom and laboratory equipment, etc.).

IX. Online Delivery of Program

If you are requesting approval to offer the proposed program online, please describe your capacity to do so with reference to existing digital infrastructure (e.g., course management systems, technical support). Then answer the following:

  1. How many programs are currently offered online?
  1. Does your institution have approval from its regional or national accrediting body to offer online courses? If so, when was this granted?

Appendix A

Curriculum Table

Provide a list, in sequence, of the course requirements in the table below. Include course number and title. Please see page one for definitions of modalities.

Attach course descriptions and syllabi for all new courses in the program core and in each concentration/track/option.

Program Core Courses (with concentrations) / Credit Hours / New / On Ground / Online

Elective Courses

General Education Courses

Appendix B

Resource Summary

I. Projected Enrollment

Provide projected enrollment numbers for internal transfers, new students, returning students, and total enrollment during each of the first three years of the program. Be sure to distinguish full-time and part-time students.

Projected Fall Year One Fall Year Two Fall Year Three

Enrollment Full-time Part-time Full-time Part-time Full-time Part-time

Internal Transfers
New Students
Returning Students
Total
Enrollment

II. Projected Revenue

Provide projected program revenue from tuition (full-time and part-time), student fees, other sources, and total revenue during each of the first three years of the program.

Projected Program Revenue / Year 1 FY 20 / Year 2 FY 20 / Year 3 FY 20
Full-time Tuition per Semester
Part-time Tuition per Semester
Student Fees per Semester
Other Sources (attach description)
Estimated New Program Annual Revenue

III. Projected Expenditures

Provide projected annual expenditures for administration (chair or coordinator), faculty (full-time and part-time), support staff, library resources, equipment or other learning resources, and total expenditures for each of the first three years of the program.

Year One Year Two Year Three

Annual Expenditures Number/Est. Cost Number/Est. Cost Number/Est. Cost

Administration (Chair)
Faculty (full-time total for program)
Faculty (part-time total for program)
Support Staff
Library resources proposed
Equipment (attach list)
Other (attach list and explain)
Total Annual Expenditures

Appendix C

Faculty Chart

Provide a list of all faculty members who will be teaching in the program core and concentrations/tracks/options. Designate faculty to be hired with an *.

Name, Title, and Position
(full-time, part-time, adjunct) / Credential/Institution / Area of Specialization/Pertinent Experience / Other Administrative or Teaching Responsibilities

NOTE: Institutions are required to have their current institutional program approval process on file with the Office of Higher Education.

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Please note that this application has been reformatted in Microsoft Word to enable ease of completion. Together, submit this application and a separate circulation document for the proposed program to the Office of Higher Education, which is responsible for circulating all proposed programs. Please submit as a Word document via email and as a print copy through the mail.

As a reminder, once the proposed program is circulated, a copy of the institutional responses to all comments must be sent to the Office of Higher Education at . All comments and responses will be considered in the programmatic review process.

Upon receipt of a print copy of the application, a staff member will be assigned to review your application and will contact you if additional information is needed. If no additional information is needed, you will be notified of the Office’s decision within 45 working days.

For more information, contact:

Vi Nguyen, Associate of Academic Affairs

Office of Higher Education

450 Columbus Boulevard, Suite 510

Hartford, CT 06103

(860) 947-1822

Fax: (860) 947-1309

Email:

Rev 2/2017

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