consent form

REMEMBER TO INCLUDE:

1. Two (2) Copies of your proposed application for authority that you

will be filing with the

New York State Department of State. This

document must have specific purposes within the document in the

purpose claus

e. IF there is no pu

rpose clause, please add an extra

paragr

aph with this information before

the signature. Please read the

disclaimers in Question 5 of the Frequently Asked Questions and if any

apply to your corpor

ation/company, please

include them in the

paragr

aph containing the purposes

2. A copy of your certificat

e of good standing from your incorporating

state. A copy of your original certificate of incorporatio

n and any

previously filed amendments from your incorporation state.

3. A cover letter with complete contact information.

4. A stamped self-addressed envelope.

5. The appropriate check-$10 for a nonprofit or $20 for a business –

made payable to NYS Education Department

6. Th

e completed consent form.

7. Please confirm with the Department of State whether a corporate

indicator (ie. "Inc.") needs to be included within the corporat

e name.

______________________________

STATE OF NEW YORK

THE STATE EDUCATION DEPARTMENT

Albany, New York

CONSENT TO FILING WITH THE DEPARTMENT OF STATE

(General Use)

Consent is hereby given to the filing of the annexed application for authority

of ________________________________________________________________________,

[name of entity]

pursuant to the applicable provisions of the Education Law, the Not-for-Profit Corporation Law,

the Business Corporation Law, the Limited Liability Company Law or any other applicable

statute.

This consent is issued solely for purposes of filing the annexed document by the

Department of State and shall not be construed as approval by the Board of Regents, the

Commissioner of Education or the State Education Department of the purposes or objects of such

entity, nor shall it be construed as giving the officers or agents of such entity the right to use the

name of the Board of Regents, the Commissioner of Education, the University of the State of

New York or the State Education Department in its publications or advertising matter.

IN WITNESS WHEREOF this instrument is

executed and the seal of the State Education

Department is affixed.

Betty A. Rosa

Commissioner of

Education

By:

Commissioner's authorized designee

Date

THIS DOCUMENT IS NOT VALID WITHOUT THE SIGNATURE OF THE

COMMISSIONER’S AUTHORIZED DESIGNEE AND THE OFFICIAL SEAL OF THE

STATE EDUCATION DEPARTMENT.