1. LOIS PROGRAM APPLICATION
      1. _______ Reapply an existing program to WIA
      2. Division: _________________________________ CIP Code: ____________________
      3. Program Title: ________________________________________________________________
      4. Contact Person: ___________________________ Title: ____________________________
      5. Email Address: ___________________________   Phone #: _________________________
      6.                                                                      
      7. I have reviewed the information for the above program and have made the necessary corrections. I certify that this information is correct to the best of my knowledge.
      8. Authorizing Signature: __________________________________ Date: ________________
      9.      For I. R. Office use only                       Only 1 Program per Application, Please.
      10.    

 

LOIS PROGRAM APPLICATION

 

 

_______ Submit a new program to WIA

_______ Reapply an existing program to WIA

        (No Changes Made)


_______ Reapply an existing program to WIA

           (Changes Noted on Application)

______ Delete an existing program from WIA


Division: _________________________________ CIP Code: ____________________


Program Title: ________________________________________________________________


Contact Person: ___________________________ Title: ____________________________


Email Address: ___________________________   Phone #: _________________________


            


I have reviewed the information for the above program and have made the necessary corrections. I certify that this information is correct to the best of my knowledge.

 


Authorizing Signature: __________________________________ Date: ________________

 

 


      For I. R. Office use only        Only 1 Program per Application, Please.


   


Louisiana Occupational Information System (LOIS)

Institutional Program Information

         
         

Program Title

 

 

 

 

 

 

 

 
         

Completion Level

 

 

Associate Degree

   
 

 

 

Associate of Applied Science

   
 

 

 

Certificate less than 3 months

   
 

 

 

Certificate 3 months to 6 months

   
   

Certificate 6 months to 1year

   
 

 

 

Certificate 1 year to 2 years

   
         

 

 

 

 

 

 

 

 

   

       

National

 

State Regional

(Indicate Highest Level)

         
 

Program Description

       

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
         
         

Date Program First Implemented _______/________/_________

(Required Field)

         

Pell Eligible:

 

Yes No

   
         

Class Availability (check all that apply)

 

Day

 

Evening

 

Weekend

         

Program Length

 

 

(Number Hours)

   
         

Program Length Type

 

Credit Hours

   

(choose appropriate type)

       
   

Clock Hours (non-credit only)

   
         
         

Classroom Time

 

Lecture only (e.g., 3hrs x 15wks per semester = 45 hrs)  

 

(in Hours)

       
         

Other Time in Hours

 

Practicum, Clinical, etc. (e.g.,15wks per semester x lab hrs)  

 

 

Louisiana Occupational Information System (LOIS)

Credit Program Cost

         
         
         

Total Tuition Cost*

$

   

(Upon Completion)

* Other Costs must be listed separately.

   
         

 

 
 

# of Full-time Fall and Spring Semesters

   
         

 

 
 

# of Full-time (6 credit hours) Summer Sessions

   
         

 

Fall/ Spring

 

Summer

Number of Semesters

Cost

 

Number of Semesters

Cost

 

 

 
   

 

 

1

$915.00

 

1

$555.00

2

$1,830.00

 

2

$1,110.00

3

$2,745.00

 

3

$1,665.00

4

$3,660.00

 

4

$2,220.00

5

$4,575.00

 

5

$2,775.00

6

$5,490.00

 

6

$3,330.00

7

$6,405.00

 

7

$3,885.00

 

 

Other Costs

       
     

Description of Cost

       

Registration Fee

$

 

One time application fee

Lab Fees

$

 

 

 

Books

$

 

 

 

Supplies

$

 

 

 

Uniform

$

 

 

 

Other Costs

$

 

 

 

Certification Exam

$

 

 

 
       

Lab Fees:

For required and elective courses according to current class schedule, including General Education requirements. (Please Itemize)

 

 
       

   

Books:

Presently applying the following estimated average: {$60 per course x total # of coursed to complete}. Include all General Education requirements in this figure. Please provide other figures, if this does not describe the probable cost of textbooks, notebooks, etc. for the program.

 

 
       

   

Supplies:

e.g., video tapes, stethoscope, surgical gloves, work gloves, hand tools, equipment, etc.

   

 

 
       

   

Uniform:

Apron, lab coat, scrubs, etc. Please note that usually more than one uniform is needed.

   

 

 
       

   

Other Costs:

e.g., parking fees, transportation to internship site etc.

   

 

Louisiana Occupational Information System (LOIS)

Continuing Education - Only

Program Cost

         
         
         

Total Tuition Cost*

 

$

   

(Upon Completion)

 

* Other Costs must be listed separately.

   
         

 

List the required courses in sequence to complete this CE Program Certificate

         

Seq #

Course Title

Hours

Cost

1

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

5

 

 

 

 

 

 

 

6

 

 

 

 

 

 

 

7

 

 

 

 

 

 

 

8

 

 

 

 

 

 

 

10

 

 

 

 

 

 

 

11

 

 

 

 

 

 

 

12

 

 

 

 

 

 

 

13

 

 

 

 

 

 

 

14

 

 

 

 

 

 

 

15

 

 

 

 

 

   

 

Other Costs

         
     

Description of Cost

 
         

Materials Fees

$

 

 

 
 

Books

$

 

 

 
 

Supplies

$

 

 

 
 

Uniform

$

 

 

 
 

Other Costs

$

 

 

 
 

Certification Exam

$

 

   

 

 


 

 

 

Qualifications, Prerequisites and Equipment

         
         
         

Describe the minimum entry-level requirements or prerequisites in 200 words or less:

(If less than college admission policy)

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
         
         

Describe any major equipment used in this program and the availability in 200 words or less:

(If no equipment is required for this program, please enter NONE.)

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
         
         
         

Equipment to Student Ratio: (ex 1:3) _______________

         
         
         

Describe Industry Support in 200 words or less:

   
         

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
         
         
         
         

 

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