Non-New York State Authorization Form
The purpose of this form is to collect an accurate census of educational activities conducted outside of New York State. These educational activities may require additional authorization.
Email address *
CONTACT & PROGRAM INFORMATION
First Name *
Your answer
Last Name *
Your answer
Title *
Your answer
E-mail *
Your answer
Phone *
Your answer
School *
Degree *
Your answer
Current Program Title *
Your answer
New Program Title (if applicable)
Your answer
Type of Request *
This program is offered as *
PROCTORING
Do you intend to offer proctoring services related to the program outside of New York State? *
MARKETING & ADVERTISING
Does the program or school plan to conduct any marketing or advertising for the program? This would not include any advertising or marketing conducted by the Office of Undergraduate Admissions. *
FIELD TRIPS
Will this program include or be associated with any field trips outside of NYS and within the US? *
Required
FACE-TO-FACE INSTRUCTION
Will face-to-face instruction occur outside of NYS and within the US? *
FACULTY STATE OF RESIDENCE
Will the program employ any faculty who will both reside and teach in the program outside of New York State? *
DISTANCE EDUCATION
Will any portion of the program be offered via distance education? *
NON-CLASSROOM EXPERIENCE
Does the program have a non-classroom experience (e.g., internship, practicum, clinical)? *
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