Private Vocational Institutions Office 401-1181 Portage Avenue Winnipeg, MB R3G 0T3 Ph.

: 204-945-8515 www.manitoba.ca/pvi APPLICATION FOR PROGRAM REVIEW - CHECKLIST 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: 1) 2) 3) 4) There are no typographical errors in your application. There are no calculation errors in your application. Your Employer/Industry Association Attestations are independent sources. All mandatory components listed below are submitted in your application.

PRIVATE VOCATIONAL INSTITUTIONS OFFICE DOCUMENTS TAB 1) PART I - INSTITUTION AND PROGRAM INFORMATION ......................................... PART II - ENTRANCE REQUIREMENTS .................................................................. PART III - GOALS & OBJECTIVES ........................................................................... PART IV - LABOUR MARKET ANALYSIS ............................................................... PART V - PROGRAM REVIEW .............................................................................. PART VI - STUDENT EVALUATION ........................................................................ PART VII - DECLARATION .................................................................................... TAB 2) PROGRAM REVIEW CONTENT ..............................................................................

SUPPORTING DOCUMENTATION & APPENDICES TAB 3) TAB 4) TAB 5) TAB 6) TAB 7) TAB 8) EMPLOYER ATTESTATIONS (MINIMUM 3 REQUIRED) SAMPLE LESSON PLAN (1 REQUIRED) SAMPLE EXAM (1 REQUIRED) ............................................

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SAMPLE DIPLOMA/CERTIFICATE (1 REQUIRED) SAMPLE TRANSCRIPT (1 REQUIRED) INSTRUCTOR DECLARATIONS (FORM 2)

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The instructor declaration(s) is/are not necessarily required at the time of program submission if the instructor(s) have not been hired. However, a Form 2 will be required prior to program offering.

TAB 9)

PRACTICUM/WORK EXPERIENCE DOCUMENTATION
Evaluation, Guidelines, etc.

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TAB 10) COMPLETE CURRICULUM (1 REQUIRED) TAB 11) LABOUR MARKET ANALYSIS

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PLEASE MAKE CHEQUE PAYABLE TO THE MINISTER OF FINANCE

Private Vocational Institutions Office 401-1181 Portage Avenue Winnipeg, MB R3G 0T3 Ph.: 204-945-8515 www.manitoba.ca/pvi APPLICATION FOR PROGRAM REVIEW NOTE: 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. 3) An incomplete program submission will not be considered and will be returned to the educational institution. PART I - INSTITUTION AND PROGRAM INFORMATION 1) Institution Name 2) Program Name 3) Contact Person 5) Email Address 6) Website Program Cost Information (a) Tuition (b) Training Completion Fund (c) Books & Supplies (d) Registration Fee (Max. $225) (e) Admin/Other Fees (specify)* (f) Total Program Cost Program Duration Information (in hours) (g) Theory Component (h) Practical Component (i) Practicum Component (j) Total Program Duration 0 + + + $ $ + + + + 4) Phone Number

PART II - ENTRANCE REQUIREMENTS Include the educational and age minimum requirements, as well as any required aptitude tests for entry into this program.

FORM 3 - PROGRAM SUBMISSION

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PART III - GOALS AND OBJECTIVES 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 (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.)

(c) Please note that 3 attestations are required for the Labour Market Component of this application. Refer to your Program Submission Checklist for where those attestations are placed in the order of your submission. PART V - PROGRAM REVIEW (a) How will this program be delivered? Please indicate all that apply. Classroom Self-directed learning Distance education

FORM 3 - PROGRAM SUBMISSION

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PART V - PROGRAM REVIEW (con't) (b) Please provide a breakdown of the theory, practical and practicum hours by unit/lesson or course name: Unit/Lesson/Course Name Theory Practical Practicum Total 1 0 2 0 3 0 4 0 5 0 6 0 7 0 8 0 9 0 10 0 11 0 12 0 13 0 14 0 15 0 16 0 17 0 18 0 19 0 20 0 21 0 22 0 23 0 24 0 25 0 26 0 27 0 28 0 29 0 30 0 31 0 32 0 33 0 34 0 35 0 36 0 37 0 38 0 39 0 40 0

FORM 3 - PROGRAM SUBMISSION

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Also provide publication dates of required texts.PART V . practical. (Hours on Page 1 compared to Hours calculated above in Part V) Total Theory Hours 0 Total Practical Hours 0 Total Practicum Hours 0 Total Program Duration (in Hours) 0 (d) List the details of the equipment that will be used in the delivery of the program and the availability to students: 1 3 5 7 9 2 4 6 8 10 (e) List the details of the textbooks/print materials to be used or acquired by the student in completing the program.PROGRAM SUBMISSION 5 OF 86 .PROGRAM REVIEW (con't) Total Theory Hours Total Practical Hours Total Practicum Hours Total Program Duration (in Hours) 0 0 0 0 0 0 0 (c) There are discrepancies in your theory. Detail of required textbooks/print materials 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Publication Date FORM 3 . or practicum calculations if any of the hours below do not equal 0.

STUDENT EVALUATION The student evaluation component of your program submission must include the following documents/samples.PART VI . IF REQUIRED.00 AS REGISTRANT OF THE INSTITUTION.PROGRAM SUBMISSION 6 OF 86 . OR HAS A CONTROLLING INTEREST IN THE PROGRAM CURRICULUM AND.DECLARATION FEE PAYABLE BY A REGISTRANT FOR APPLYING TO HAVE A PROGRAM OF INSTRUCTION CONSIDERED FOR APPROVAL IS ATTACHED: NEW PROGRAM AMENDED PROGRAM $275. Submitted by: Date Signature FORM 3 . TO BE ARTICULATED IN APPENDIX 2 . Please refer to your Program Submission Checklist for where this section of your submission must be located. etc. I DECLARE THAT THE INSTITUTION IS NOT SUBJECT TO ANY CONTRACTUAL PROVISION THAT MIGHT INTERFERE WITH THE ADMINISTRATION AND DELIVERY OF THIS PROGRAM.00 $100. I DECLARE THAT THE INSTITUTION OWNS.(PROGRAM REVIEW . CAN PROVIDE APPROPRIATE DOCUMENTATION OF PROGRAM OWNERSHIP. AS REGISTRANT OF THE INSTITUTION.CONTENT) (a) (b) (c) (d) Student Feedback received from evaluation process Assistance available to students upon completion of the program Clear description of student progress and final competencies Required pass mark for each course/section of the program and for the overall program TO BE ATTACHED TO YOUR PROGRAM SUBMISSION APPLICATION (see Checklist) (e) (f) (g) (h) Sample Lesson Plan (TAB 5) Sample Exam (TAB 6) Sample Diploma/Certificate (TAB 7) Sample Transcript (TAB 8) PART VII .

tests. etc.: 204-945-8507 www.Private Vocational Institutions Office 401-1181 Portage Avenue Winnipeg.ca/pvi PROGRAM REVIEW CONTENT Course Information 1 0 Course Description Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → → → → → → → Evaluations (Assignments.manitoba.) → → → → → → → Page 7 . MB R3G 0T3 Ph.

tests.) → → → → → → → → → → → → → → → → → → Page 8 .Course Information 2 0 Course Description Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → Evaluations (Assignments. etc.

) 0 0 0 Competencies to be achieved: → → → → → → → → → → → → → → → → → → → → → → Page 9 . etc. tests.Course Information 0 Course Description 3 Theory Practical Practicum Passing Grade Evaluations (Assignments.

) → → → → → → → → → → → → → → → → → Page 10 . tests.Course Information 0 Course Description 4 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. etc.

) → → → → → → → → → → → → → → → → → Page 11 . etc.Course Information 0 Course Description 5 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. tests.

Course Information 0 Course Description 6 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.) → → → → → → → → → → → → → → → → → Page 12 . tests. etc.

) → → → → → → → → → → → → → → → → → Page 13 .Course Information 0 Course Description 7 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. tests. etc.

etc.Course Information 0 Course Description 8 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.) → → → → → → → → → → → → → → → → → Page 14 . tests.

tests.) → → → → → → → → → → → → → → → → → Page 15 . etc.Course Information 0 Course Description 9 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.

etc. tests.) → → → → → → → → → → → → → → → → → Page 16 .Course Information 0 Course Description 10 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.

etc.Course Information 0 Course Description 11 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.) → → → → → → → → → → → → → → → → → Page 17 . tests.

) → → → → → → → → → → → → → → → → → Page 18 .Course Information 0 Course Description 12 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. tests. etc.

) → → → → → → → → → → → → → → → → → Page 19 . tests.Course Information 0 Course Description 13 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. etc.

etc.) → → → → → → → → → → → → → → → → → Page 20 . tests.Course Information 0 Course Description 14 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.

etc.) → → → → → → → → → → → → → → → → → Page 21 .Course Information 0 Course Description 15 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. tests.

) → → → → → → → → → → → → → → → → → Page 22 .Course Information 0 Course Description 16 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. etc. tests.

etc. tests.Course Information 0 Course Description 17 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.) → → → → → → → → → → → → → → → → → Page 23 .

tests. etc.) → → → → → → → → → → → → → → → → → Page 24 .Course Information 0 Course Description 18 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.

Course Information
0

Course Description

19 Theory Practical Practicum Passing Grade 0 0 0

Competencies to be achieved:
→ → → → →

Evaluations (Assignments, tests, etc.)

→ → → → → → → → → → → → → → → → →

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Course Information
0

Course Description

20 Theory Practical Practicum Passing Grade 0 0 0

Competencies to be achieved:
→ → → → →

Evaluations (Assignments, tests, etc.)

→ → → → → → → → → → → → → → → → →

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Course Information
0

Course Description

21 Theory Practical Practicum Passing Grade 0 0 0

Competencies to be achieved:
→ → → → →

Evaluations (Assignments, tests, etc.)

→ → → → → → → → → → → → → → → → →

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Course Information
0

Course Description

22 Theory Practical Practicum Passing Grade 0 0 0

Competencies to be achieved:
→ → → → →

Evaluations (Assignments, tests, etc.)

→ → → → → → → → → → → → → → → → →

Page 28

etc.) → → → → → → → → → → → → → → → → → Page 29 .Course Information 0 Course Description 23 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. tests.

) → → → → → → → → → → → → → → → → → Page 30 .Course Information 0 Course Description 24 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. etc. tests.

tests.) → → → → → → → → → → → → → → → → → Page 31 .Course Information 0 Course Description 25 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. etc.

) → → → → → → → → → → → → → → → → → Page 32 . tests.Course Information 0 Course Description 26 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. etc.

Course Information 0 Course Description 27 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. tests. etc.) → → → → → → → → → → → → → → → → → Page 33 .

tests.Course Information 0 Course Description 28 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.) → → → → → → → → → → → → → → → → → Page 34 . etc.

Course Information 0 Course Description 29 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. tests. etc.) → → → → → → → → → → → → → → → → → Page 35 .

) → → → → → → → → → → → → → → → → → Page 36 . tests.Course Information 0 Course Description 30 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. etc.

tests.Course Information 0 Course Description 31 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. etc.) → → → → → → → → → → → → → → → → → Page 37 .

etc. tests.) → → → → → → → → → → → → → → → → → Page 38 .Course Information 0 Course Description 32 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.

etc.Course Information 0 Course Description 33 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.) → → → → → → → → → → → → → → → → → Page 39 . tests.

Course Information 0 Course Description 34 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. tests.) → → → → → → → → → → → → → → → → → Page 40 . etc.

) → → → → → → → → → → → → → → → → → Page 41 . etc. tests.Course Information 0 Course Description 35 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.

) → → → → → → → → → → → → → → → → → Page 42 . tests. etc.Course Information 0 Course Description 36 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.

Course Information 0 Course Description 37 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.) → → → → → → → → → → → → → → → → → Page 43 . tests. etc.

etc. tests.Course Information 0 Course Description 38 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments.) → → → → → → → → → → → → → → → → → Page 44 .

Course Information 0 Course Description 39 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. tests. etc.) → → → → → → → → → → → → → → → → → Page 45 .

) → → → → → → → → → → → → → → → → → Page 46 . etc.Course Information 0 Course Description 40 Theory Practical Practicum Passing Grade 0 0 0 Competencies to be achieved: → → → → → Evaluations (Assignments. tests.

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