Application Cover Page

Texas Skill Standards Based Program Recognition

All colleges applying for program recognition must complete the information below. A separate application cover page must be submitted for each program (level two certificate or associate’s degree) for which recognition is being sought. Please see instructions in section IV of the Application for Texas Skill Standards Based Program Recognition at www.tssb.org/applications. This form may be downloaded from the same web page and completed electronically. (See help text in the status line for each field.)
College name:
Program award:
Title Level (select one)
Program status:
New/Revision/Existing If new or revision, proposed implementation date
Local needs courses added to award? If so, note course rubric/#s & attach copies.
Title of skill standards incorporated into curriculum:
Program contact name: (Enter single program contact for all campuses)	Program contact title:
Mailing address: City: State: Zip Code:
TX
Telephone:	Email:
List all campuses where the program is offered:
College statement of intent to incorporate skill standards into curriculum and report additional campuses:
The signature of the college representative named below indicates that: 1) the institution has incorporated all the skill standards elements into the program award for which it is seeking recognition, as documented in a matrix aligning the key activities (or equivalent element) with the program’s courses in which they will be assessed; 2) the institution will: a) teach each key activity (or equivalent element) as a learning outcome in the courses specified; b) teach the related academic, employability, and occupational knowledge, skills and conditions in the program; and c) assess students’ performance of the key activities and/or related performance criteria, skills and knowledge; and 3) the college agrees to provide documentation of its compliance with these statements under a desk audit if requested by the Texas Workforce Investment Council. After this application is approved, the college also agrees to submit the program recognition application supplement whenever the recognized program is offered at additional campuses.
Signature of college president/chancellor or chief instructional officer:	Date
Name of president/chancellor or chief instructional officer:	Title:
Industry advisory committee statement of support for skill standards based curriculum:
The signature of the program’s industry advisory committee chair named below indicates that the industry advisory committee supports the program’s skill standards based curriculum and the college’s intention to teach and assess students to the skill standards content, including the key activities (or equivalent element) and related criteria, skills and knowledge.
Signature of industry advisory committee chair:	Date
Name of industry advisory committee chair:	Title and Company:
FOR TWIC USE ONLY
Staff review by:	Recognized
Application approval date:	Does not meet recognition requirements