2017-02-28

Out-of-state non-SARA institutions seeking approval to offer distance education in New York State may use this form to request that the application submission period be extended.

Institution

Institution Name *

OPEID *

Institution Address *

Accreditor *

President/CEO

President/CEO Name *

President/CEO Telephone *

Required phone number format: 555-555-1234

President/CEO Email *

Enter a valid email address (e.g., username@domain.com)

Primary Contact

Primary Contact Name *

Primary Contact Title *

Primary Contact Telephone *

Required phone number format: 555-555-1234

Primary Contact Email *

Enter a valid email address (e.g., username@domain.com)

Current New York State Distance Education Enrollment

Full-time Students *

Part-time Students *

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Math question *
3 + 10 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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