Form OS

OFF-SITE DELIVERY OF AN EXISTING PROGRAM FORM

Sponsoring Institution (s): _________________________________________________

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Name of Institution (Campus or off-campus residential center in the case of multi-campus institutions).

Program Title: _________________________________________________

Degree/Certificate: _________________________________________________

Institution Granting Degree: _________________________________________________

Delivery Site(s): _________________________________________________

Mode of Program Delivery: _________________________________________________

_________________________________________________

Geographic Location of Student Access:_________________________________________________

_________________________________________________

CIP Classification: ________________________ (Please provide CIP code)

Implementation Date: _________________________________________________
Semester and Year

Cooperative Partners:_________________________________________________

_________________________________________________

AUTHORIZATION

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Name/Title of Institutional Officer     Signature     Date

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Person to Contact for More Information     Telephone