|
Application and Institutional Profile
Complete and mail to
International Commission on Academic Accreditation,
Inc.
2718 West Walnut St., Rogers, AR 72756
Basic Information
Institution___________________________________________________________________
Number or P.O. Box _____________________ Street _______________________________
City_________________________State_______Country____________Postal Code
_______
Physical Address______________________________________________________________
Telephone (____) ________________________ Fax (____) ___________________________
Email: ______________________________________________________________________
Web Site: ___________________________________________________________________
Alternate Contact
Information - Other than a family member
Name _____________________________________________________________________
Number or P.O. Box _____________________ Street _______________________________
City_________________________State_______Country____________Postal Code
_______
Physical Address______________________________________________________________
Telephone (____) ________________________ Fax (____) ___________________________
Administration
Position
Title Currently Used Highest Earned
Degree
President (Superintendent) __________________________ _____________________
__________________
Academic Dean (Principal) __________________________ _____________________
__________________
Business Manager __________________________________ _____________________
__________________
History
Date institution was chartered, incorporated or authorized _____________________________
Date institution first enrolled students______________________________________________
Date institution graduated (or will graduate) its first class_______________________________
Institutional
Characteristics
1. Type(s) of control
2. Type(s) of program(s)
_____ Independent, non-profit
_______ Undergraduate
______ Religious group
_______ Liberal arts & general
______ Other: _____________________ _______ Teacher preparatory
_______ Professional
_______ Others: _______________
3. Level(s) of
offerings(s)
4. Type of facility where classes are held:
______ Diploma or certificate
______ Regular independent campus
facility
______ Associate degree
______ Church facility used as campus
______ Baccalaureate
______ Converted building used for campus
______ Masters
______ Other (describe briefly the facility)
______ Professional Degree
_______Facility used is owned______
leased______
______ Doctorate
______Other: ___________________
5. Type of calendar
system
______ Semester ______
Quarter ______Other:_________________
6. By what agency
is the institution legally authorized to grant degrees/diplomas?
_________________________________________________
_____ Religious Exempt
_____ Non-Exempt
7. Approval to
grant degrees/diplomas
Date of initial approval to grant degrees/diplomas ________/_________/_________
8. Church Affiliation
(Does not affect the status of this application)
Church or Denomination _______________________________________________________
9. Teaching Faculty:
Full-Time
Name:_________________________________________ Highest Earned Degree
________
Name:_________________________________________ Highest Earned Degree
________
Name:_________________________________________ Highest Earned Degree
________
Name:_________________________________________ Highest Earned Degree
________
Name:_________________________________________ Highest Earned Degree
________
Name:_________________________________________ Highest Earned Degree
________
Name:_________________________________________ Highest Earned Degree
________
Attach additional pages as needed
10. Faculty History
Number with earned accredited doctoral degree
________________
Graduate or Undergraduate Faculty ________________
Number of master's who are doctoral candidates ________________
Graduate or Undergraduate Faculty ________________
Number with earned accredited master's degree
________________
Graduate or Undergraduate Faculty ________________
Number with earned accredited bachelor's degrees ________________
11. Teaching Faculty
- Part Time
List those contracted to teach by the course, tutors and academic
advisors. Administrators who teach are considered part-time faculty. Give
the same information as in item 10.
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
12. Definitions
K-12 Faculty
- Those who are qualified and contracted to teach any number
of classes.
Undergraduate Faculty:
- Those who are qualified and contracted to teach the equivalent
of 12-15 hours per semester, or 24-30 hours per academic year at the undergraduate
level. (Do not include administrators such as President, Vice President,
Provost)
Graduate Faculty:
- Those who are qualified and contracted to teach the equivalent
of 9-12 hours per semester, or 18-24 hours per academic year at the graduate
level. (Do not include administrators such as President, Vice President,
Provost)
13. Board of
Directors
List all members of the Institution's Board of Directors and their positions
Name ______________________________ Position ______________________________
Name ______________________________ Position ______________________________
Name ______________________________ Position ______________________________
Name ______________________________ Position ______________________________
Name ______________________________ Position ______________________________
Attach additional pages as needed
12. Other Institutional
Accreditation Memberships
Name ______________________________________ Location __________________________
Name ______________________________________ Location __________________________
Name ______________________________________ Location __________________________
Name ______________________________________ Location __________________________
Attach additional pages as needed
13. Financial (Current
Year; Include Annual Financial Statement)
Income____________________ Expenditures____________________
Surplus (Deficit)_____________________
14. The information
given above is correct and is an accurate portrayal of the institution.
Name of the person completing this form:
__________________________________
Signature: ________________________________________ Date: ______________
President's/Superintendent Name: _____________________________________________________
President's Signature/Superintendent: _______________________________
Date: ______________
Notary
My commission expires: ______________________________
(20____)
|