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.    

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: