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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
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MN
MS
MO
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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:
10/23/2021
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