New York State Education Department

Student Support Services

Education Building, Room 318-M

Albany, NY 12234

SCHOOL VIOLENCE PREVENTION AND INTERVENTION

COURSE WORK PROVIDER AGREEMENT

The applicant/provider agrees that the course work or training will cover, as a minimum, the required components contained in paragraph (a) of Part 57-2.3 of the Regulations of the Commissioner. The applicant/provider agrees that the course work will be current, relevant and appropriate for the professionals in the target audience.

The applicant/provider agrees that, if additional instructional staff members are selected, those persons will possess training, experience, or earned degrees comparable to staff identified in the application.

The applicant/provider attests that the target audience will be comprised of individuals applying for certification as teacher assistants, teachers, pupil personnel services professionals and school administrators.

The provider agrees to upload electronically to a designated site, and in a format established by the State Education Department, within 21 calendar days, each person’s completion of the coursework or training. The provider agrees to assume the cost of reproducing this and any other training-related paper work. The provider further agrees to assume the cost of postage, handling, or any other cost associated with sending material to the State Education Department.

The provider agrees to retain verification of completion (this may be electronic or paper file) and copies of all program and promotional materials used for each course, for not less than six years from the date of completion of the course work. These records are subject to review by the Department, and provider agrees to make these records available to the Department or its designee during regular business hours at the specified location. The provider agrees to notify the Department in advance of any location change of these records prior to the expiration of the six-year period, and to respond to any Department inquiry regarding these records.

The applicant/provider understands and agrees that the State Education Department may review and evaluate the course work or training offered and that the termination of a provider's approved status may result if the Department determines that the course work or training is inadequate, incomplete, or otherwise unsatisfactory.

The applicant/provider understands and agrees that failure to comply with this Agreement, or failure to substantiate the capability to offer the course work or training, or misrepresentation of requirements or status, may result in the termination of the Provider Agreement by the Department.

The applicant/provider understands and agrees that the term of continued approval as a provider is six years. At the expiration of this term, a provider may reapply to the State Education Department for approval to continue to offer the course work. The applicant/provider further agrees that if coursework or training is discontinued, all copies of certifications of completion issued within the six years prior to such discontinuance shall be transferred to the department.

Signature of Authorized Official	Date

Print or Type Name	Title

11/13/17