Application For Approval Of Ramp Online Curriculum (Page 4 of 4) in pdf

INSTRUCTIONS

This application is for the approval of a Responsible Alcohol Management Program (RAMP) server/seller online

curriculum only. Any person who wishes to use this curriculum must submit a separate application to seek

approval as a RAMP online instructor.

1. A nonrefundable application fee of $250.00 is required by any individual submitting a curriculum for review and

approval as a RAMP server/seller online course. Please make a check or money order payable to “Commonwealth

of PA.” Do not send cash.

2. Submit completed application, fee, and login credentials for online course to the Pennsylvania Liquor Control

Board(PLCB), RAMP, 990 Briarsdale RD, Unit A Harrisburg, PA, 17109.

If you require assistance in completing this application, call the RAMP office at 866.275.8237.

ACKNOWLEDGEMENT

I UNDERSTAND THAT I MUST SUBMIT AN ONLINE COURSE AS DEFINED IN THE PLCB GUIDELINES FOR REVIEW AND APPROVAL.

__________________________________________________________________________________________________________________________________________________________________________

I UNDERSTAND THAT ONCE THE ONLINE COURSE IS APPROVED, I AM NOT PERMITTED TO MAKE ANY CHANGES WITHOUT APPROVAL

FROM THE PLCB, BUREAU OF ALCOHOL EDUCATION.

__________________________________________________________________________________________________________________________________________________________________________

I UNDERSTAND THAT THE PLCB WILL REQUIRE A PILOT DEMONSTRATION OF MY PROPOSED ONLINE COURSE BEFORE GRANTING

APPROVAL.

__________________________________________________________________________________________________________________________________________________________________________

I UNDERSTAND THAT I HAVE THE BURDEN OF PROVIDING THAT THIS CURRICULUM MEETS ALL OF THE REQUIREMENTS SET FORTH

BY THE PLCB.

_____________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________

I SWEAR OR AFFIRM, SUBJECT TO THE PENALTIES PROVIDED BY 18 PA. C.S. 4904, THAT THE FOREGOING ANSWERS AND STATEMENTS

PROVIDED HEREIN ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

_____________________________________________________________________________________

SIGNATURE

DATE

_________________________________________________________________________

PLCB Use Only

FIRST REVIEW:

____ / ____ / ____

Date of Review:

Approved:

Yes