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SARA Supplemental Form for Institutions
Name of the Institution:
Enrolled FTE
Annual Fee
Under 2,500
$750
2,501-20,000
$3,000
20,001 or more
$7,500
Title:
First Name
Last Name
Address
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
Phone
Email Address
I, the undersigned representative of the above-named institution, will follow the best practices of our accreditor as to closing a program, site, branch or institution. Our institution is accredited by (no acronyms):
Signature:
3/21/2023
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