Untitled Document


	Online Application

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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 has at least two full time faculty	Yes	No
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

The institution certifies that all information provided on this form is accurate to the best of its knowledge.	I agree

Please submit the following via postal mail:
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 Dr. Melodye Lehnerer, Chair 6375 West Charleston - W10E Las Vegas, NV 89146

Page last updated: 4/09/08