form 3 program submission 97 03
TRANSCRIPT
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APPLICATION FOR PROGRAM REVIEW - CHECKLIST
Private Vocational Institutions Office
401-1181 Portage Avenue
Winnipeg, MB R3G 0T3
Ph.: 204-945-8515 www.manitoba.ca/pvi
PART III - GOALS & OBJECTIVES
2) There are no calculation errors in your application.
3) Your Employer/Industry Association Attestations are independent sources.
PRIVATE VOCATIONAL INSTITUTIONS OFFICE DOCUMENTS
TAB 1)
All mandatory components listed below are submitted in your application.
TAB 2)
...........................................................................
PART IV - LABOUR MARKET ANALYSIS
Private Vocational Institutions will need to provide all information required on this checklist, and in the
order provided. A Program Submission package example has been prepared for you to ensure that your
submission is well-organized. Please consider the following when preparing your submission:
There are no typographical errors in your application.1)
..................................................................
4)
PART I - INSTITUTION AND PROGRAM INFORMATION .........................................
PART II - ENTRANCE REQUIREMENTS
..............................................................................
...............................................................
PART V - PROGRAM REVIEW ..............................................................................
PART VI - STUDENT EVALUATION ........................................................................PART VII - DECLARATION ....................................................................................
PROGRAM REVIEW CONTENT
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6) Website
+
(d) Registration Fee (Max. $225)
(c) Books & Supplies
+(b) Training Completion Fund
(a) Tuition
5) Email Address
3) An incomplete program submission will not be considered and will be returned to the
educational institution.
APPLICATION FOR PROGRAM REVIEW
PART I - INSTITUTION AND PROGRAM INFORMATION
1) Hand-written material will not be accepted, including Employer Attestations.2) All shaded areas in FORM 3 (PARTS I to VII) must be completed in full.
4) Phone Number
1) Institution Name
2) Program Name3) Contact Person
-$
+
+
Program Cost Information
Private Vocational Institutions Office401-1181 Portage AvenueWinnipeg, MB R3G 0T3
NOTE:
Ph.: 204-945-8515 www.manitoba.ca/pvi
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(a) Provide a description of the specific types of employment for which a graduate of the program would
be qualified (supporting documents also required):
(b) Provide the specific local or provincial need for graduates of the proposed program, verified by recent
labour market analysis (sources include industry sectors, organizations, councils, etc.)
Provide a comprehensive summary of the skills and knowledge a student may acquire from the program
and a statement of what the student will be able to accomplish as a result of successful completion of each
phase of the program.
PART IV - LABOUR MARKET ANALYSIS
PART III - GOALS AND OBJECTIVES
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Unit/Lesson/Course Name
(b) Please provide a breakdown of the theory, practical and practicum hours by unit/lesson or course
name:
6
7
8
9
10
1
2
3
4
5
16
17
18
19
20
11
12
13
14
15
21
22
23
24
25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Theory TotalPracticumPractical
0
0
0
0
0
0
0
PART V - PROGRAM REVIEW (con't)
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0
0 0
0 0
Total Practical Hours
Total Practicum Hours
0Total Theory Hours
(d) List the details of the equipment that will be used in the delivery of the program and the availability to
students:
1 2
Total Program Duration (in Hours)
6
(e) List the details of the textbooks/print materials to be used or acquired by the student in completing the
program. Also provide publication dates of required texts.
Detail of required textbooks/print materials Publication Date
0
8
9
3 4
5
7
1
2
10
Total Practical Hours
Total Theory Hours 0
PART V - PROGRAM REVIEW (con't)
0
Total Program Duration (in Hours)
(c) There are discrepancies in your theory, practical, or practicum calculations if any of the hours below do
not equal 0. (Hours on Page 1 compared to Hours calculated above in Part V)
Total Practicum Hours 00
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PART VII - DECLARATION
TO BE ATTACHED TO YOUR PROGRAM SUBMISSION APPLICATION (see Checklist)
Required pass mark for each course/section of the program and for the
overall program
(b)
FEE PAYABLE BY A REGISTRANT FOR APPLYING TO HAVE A PROGRAM OF INSTRUCTION
CONSIDERED FOR APPROVAL IS ATTACHED:
NEW PROGRAM
(d)
Student Feedback received from evaluation process
AS REGISTRANT OF THE INSTITUTION, I DECLARE THAT THE INSTITUTION OWNS, OR HAS A
CONTROLLING INTEREST IN THE PROGRAM CURRICULUM AND, IF REQUIRED, CAN PROVIDE
APPROPRIATE DOCUMENTATION OF PROGRAM OWNERSHIP
(h) Sample Transcript (TAB 8)
Clear description of student progress and final competencies(c)
Sample Lesson Plan (TAB 5)
(f) Sample Exam (TAB 6)
(g)
AMENDED PROGRAM
$275.00
$100.00
(e)
Sample Diploma/Certificate (TAB 7)
PART VI - STUDENT EVALUATION
Assistance available to students upon completion of the program
TO BE ARTICULATED IN APPENDIX 2 - (PROGRAM REVIEW - CONTENT)
(a)
The student evaluation component of your program submission must include the following
documents/samples, etc. Please refer to your Program Submission Checklist for where this section
of your submission must be located.
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Private Vocational Institutions Office
1
Practicum
(Assignments, tests, etc.)
Evaluations
0
0
0
Practical
Ph.: 204-945-8507 www.manitoba.ca/pvi
PROGRAM REVIEW CONTENT401-1181 Portage AvenueWinnipeg, MB R3G 0T3
Course Information
Theory
0
Course Description
PassingGrade
Competencies to be achieved:
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2
Practicum
(Assignments, tests, etc.)
Evaluations
Course Description
Course Information
0
Practical
0Theory
0
0
Passing
Grade
Competencies to be achieved:
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3
Practicum
(Assignments, tests, etc.)
Evaluations
Competencies to be achieved:
Course Description
0
Theory 0
0Practical
0
Passing
Grade
Course Information
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4
Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
Course Description
Course Information
Passing
Grade
Practical
0
Theory 0
0
0
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5
Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Course Information
Practical
Course Description
0
Theory 0
Evaluations
0
0
Passing
Grade
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6
Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
0
Theory
Evaluations
0
Practical
Course Description
0
0
Passing
Grade
Course Information
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7
Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
0
Practical
0
Evaluations
Course Information
0
Theory
0
Course Description
Passing
Grade
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8
Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Course Information
0
Passing
Grade
Course Description
Theory 0
Practical 0
0
Evaluations
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
0
Passing
Grade
Course Description
0
Course Information
Theory 0
Practical 0
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Practicum
(Assignments, tests, etc.)
Course Information
0
0 Competencies to be achieved:
Course Description
Passing
Grade
Evaluations
0
Theory 0
Practical
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Practicum
(Assignments, tests, etc.)
Course Information
Evaluations
0
0
Competencies to be achieved:
Course Description
0
Theory 0
Practical
Passing
Grade
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Course Information
Evaluations
0
Theory 0
Practical 0
Passing
Grade
0
Course Description
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Course Information
Evaluations
Practical 0
0
0
Theory 0
Course Description
Passing
Grade
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Course Information
Evaluations
0
Passing
Grade
Practical
0
0
0
Theory
Course Description
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
0
Practical 0
Course Information
Passing
Grade
Theory 0
0
Course Description
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Course Information
Evaluations
0
0
Theory 0
0
Passing
Grade
Practical
Course Description
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Theory
0
Evaluations
Course Information
Practical 0
Passing
Grade
0
Course Description
0
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
0
Course Information
Theory
0
Practical
0
Passing
Grade
0
Course Description
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Practicum
(Assignments, tests, etc.)
Evaluations
Course Information
Theory 0
Passing
Grade
Practical
0
Course Description
Competencies to be achieved:
0
0
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
Course Information
Theory
Passing
Grade
0
0
Practical 0
0
Course Description
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
0
Course Information
Passing
Grade
Practical
0
Theory 0
0
Course Description
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
Course Information
Course Description
0
Theory 0
Practical 0
0
Passing
Grade
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
Course Information
Course Description
Theory 0
0
0
Passing
Grade
Practical
0
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
Course Information
Course Description
Theory
Passing
Grade
0
Practical 0
0
0
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
Course Information
Course Description
0
Theory
Practical
Passing
Grade
0
0
0
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
Course Information
Passing
Grade
Course Description
Theory 0
Practical 0
0
0
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
0
0
Course Description
Theory
0
0
Passing
Grade
Practical
Course Information
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
Course Information
Passing
Grade
Course Description
Theory 0
Practical 0
0
0
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
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Course Information
Theory
Course Description
0
0
Practical 0
0
Passing
Grade
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
0Practical
0
Course Description
0
Theory 0
Passing
Grade
Course Information
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
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Course Information
0
Passing
Grade
0
Theory 0
Practical 0
Course Description
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
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Course Information
0
Theory
Course Description
0
Practical 0
0
Passing
Grade
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
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Practical
0
Theory
Course Description
0
0
0
Passing
Grade
Course Information
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
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Course Information
0
0
Course Description
Practical
0
Theory 0
Passing
Grade
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Evaluations
Course Information
Practical 0
Course Description
Passing
Grade
0
0
Theory 0
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
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Practical 0
Course Description
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0
Theory
Passing
Grade
Course Information
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
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Course Information
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Course Description
Practical 0
Passing
Grade
0
Theory 0
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Practicum
(Assignments, tests, etc.)
Evaluations
Course Information
Practical 0
Course Description
Competencies to be achieved:
0
Theory 0
0
Passing
Grade
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
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Course Description
0
0
Course Information
0
0
Theory
Passing
Grade
Practical
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Practicum
(Assignments, tests, etc.)
Competencies to be achieved:
Course Information
Evaluations
Course Description
Passing
Grade
0
0
0
Theory 0
Practical
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