Please complete the following questions and submit this form using the button at the bottom of this page. All information will be encrypted via our secure web server, and will be held in the strictest confidence.

We will contact you shortly with your confidential school valuation.

Name	Telephone #
E-Mail Address	School Name
1. Courses Offered (Check all that apply):
Medical	Automotive
Computer	Culinary
Secretarial	Other (please specify)

2. Published Default Rate

2007 % 2006 % 2005 %

3. Depreciation (last three years)

2009 $ 2008 $ 2007 $

4. Retention* (as a percent of those enrolled) %

5. Placement Rate* (as percent of those graduated) %

6. Gross Revenue (last three years)

2009 $ 2008 $ 2007 $

7. EBITDA ( include owner perks, addbacks)

2009 $ 2008 $ 2007 $

8. Meets 90/10 rule @

9. Accrediting Commission Valid Until 2009 2010 2011 2012 2013 2014 2015 2016

10. Average Tuition $

11. Number Years in Business

12. Composite Score (DOE):

13. Credentials Given:

Certificate

Associates

Bachelors

14. Owners Salary & Bonus $

15. Owners Insurance Premium $

16. Owners Auto Expense $

17. Owners Travel Expense $

I Certify that all information submitted herein is accurate, and that I am an authorized owner or officer of this organization. I further understand that all information will be held in the strictest of confidence by David S. Shefrin & Associates.