Form OS - Off-Site Delivery of an Existing Program
OFF-SITE DELIVERY OF AN EXISTING PROGRAM FORM
Sponsoring Institution (s): _______________________________________
_________________________________________________
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
_________________________________________________
Name/Title of Institutional Officer Signature Date
_________________________________________________
Person to Contact for More Information Telephone