Commission on Applied
and Clinical Sociology
Dr. Melodye Lehnerer, Chair 6375 W. Charleston - W10E Las Vegas, NV 89146
Phone: 702 651 5705 FAX: 702 651 5843 EMAIL:MELODYE.LEHNERER@CCSN.EDU
APPLICATION FORM
1.
Name of the Program to be accredited _________________________________
2.
Name of Department or Unit _________________________________
in which the
Program is housed
3. Name of College, School or Division _________________________________
in which Dept or
Unit is housed
4.
Name of Institution in which ________________________________
College, School or Division is housed
5. Institution Accredited by ________________________________
5a. Next Institutional Re-accreditation
date ________________________________
6. Name of Program Director ________________________________
7. Mailing address of Program ________________________________
________________________________
________________________________
________________________________
8. Telephone ________________________________
9. FAX
________________________________
10
E-mail ________________________________
11. Program Director is a full time faculty
member
in Dept/Unit in
which Program is housed ___YES ___NO
12. Department/Unit in which Program is housed ___YES ___NO
Has at least two full time faculty.
13.
Program requires practice experience ___YES ___NO
14.
Program has been in existence for two years ___YES ___NO
15.
Number of students currently ________________________________
enrolled in the
program
16. Number
of students completing
program in
last two years ________________________________
17.
Name of degree(s) received by ________________________________
students in
program ________________________________
________________________________
18.
Accreditation standards have been reviewed ___YES ___NO
Please submit with the application:
• 2 copies of the program description from
Institution’s catalogue and/or
published brochure describing the Program
• Application Fee of $100 payable to
Commission on Applied and Clinical Sociology
By signing this application, the
institution certifies
that all information provided on this
form is accurate to the best of its knowledge.
_______________________________________________________________________
Program Director date Department / Unit
Chair date
_______________________________________________________________________
Dean/Director date Chief Academic Officer date