Department of Education
Office of Career and Technical Education
www.michigan.gov/octe  
These forms are only processed in the summer of each year.   Please submit your completed form by June 30th, preceding the fall in which implementation should occur.   

                                                                                                                 DATE:
           CEPD #: 
                                                                                                  Program Name:   
                                                                                            Program CIP Code: 
                                                                                                                           Established PSN #: ______________

REQUEST FORM FOR DISCONTINUING STATE APPROVAL AND REPORTING OF SECONDARY CAREER AND TECHNICAL EDUCATION PROGRAMS

Directions:	Submission of this form to the Office of Career and Technical Education will result in the program being removed from the CTEIS 4483 enrollment reports.  Once state approval is removed, the program will no longer be allowed to report enrollments and will no longer generate Added Cost State Aid funding.  Reporting obligations resulting from previously reported enrollments including expenditures and follow-up reporting will be required.  Please submit a separate form for each program (identified by a PSN number).    A letter will be sent to the fiscal agency superintendent confirming this removal.  

Fiscal Agency:								

Operating Agency:  							

Operating Building:  							

Address:  								

Contact Person:  							    

Phone Number:  (     )		Fax Number:  (     )		Email Address:   		

Program Requested for Removal:

PSN                       	Program Name                        		    CIP Code                                       	                                                         				

Reason for Removal:
‬⁪  Program Quality Issues (TRAC)		‬	⁪  Other:  ___________________
‬⁪  Enrollment Decline					
‬⁪  Non-certified Instructor/Staff
‬⁪  Limited Options for Students	
	
____________________________________________________________________	    	_______________
Signature of Fiscal Agency Superintendent 					      	        Date

Signature of Operating Agency Superintendent					        Date

____________________________________________________________________        	    _______________ 
Signature of CEPD CTE Administrator                                                    	                       	        Date

*Please be advised that any future state approval of this or any other new career and technical education programs in your school district will be required to go through the OCTE new CTE program process.   
Submit to:
Diana Bailey, Program and Placement Specialist
 Michigan Department of Education
Office of Career and Technical Education
Post Office Box 30712
Lansing, Michigan 48909
Phone: 517/373-8904     Fax: 517/373-8776
STATE USE ONLY:  Removal Approved:   ___________________________        ________________
                                                              Signature                                     Date