<p> Columbia University’s Educational Agreement Cover Sheet (For use by CU Schools and Departments only) Date submitted: Name of Agreement (include the name of the Columbia units, name of the partner institution, and the year):</p><p>SUBMITTED BY:  Name  Email address  Title Please list all Columbia University Schools or Units (Centers, Institutes) involved: Please check Columbia ☐ Main Campus (Morningside) University campuses and ☐ CUMC locations involved: ☐ Lamont-Doherty ☐ Global Center: Amman ☐ Global Center: Beijing ☐ Global Center: Istanbul ☐ Global Center: Mumbai ☐ Global Center: Nairobi ☐ Global Center: Paris ☐ Global Center: Rio de Janeiro ☐ Global Center: Santiago Please check Columbia ☐ Faculty University personnel ☐ Post-doctoral fellows involved: ☐ Graduate students ☐ Staff ☐ Undergraduate students Please enter name and complete mailing address for each partner institution. Please briefly describe each partner institution (university, non-profit organization, for-profit company, etc). Please provide a URL for each partner institution.</p><p>Please enter start date and end date for the agreement in mm/dd/yyyy format. </p><p>Page | 1 version 2017.03.16 Please describe in 2-3 sentences the overall purpose and logistics of this agreement. List the benefits of this agreement to your unit and the University (including fit with school/University mission, advantages to Columbia faculty and/or students).</p><p>Will this agreement involve the transfer of funds between the participating institutions? Please explain.</p><p>What type of courses are ☐ Credit involved? ☐ Non-credit ☐ Not applicable</p><p>Will CU students covered by this agreement earn credits at another institution that will be applied to a CU degree? If so, what % of their CU degree will be earned at the partner institution? List any SIS codes affiliated with programs in this agreement.</p><p>Page | 2 version 2017.03.16 Please check off the This agreement seeks to establish: features of this agreement (check as many as apply): ☐ A study-abroad program (defined as Columbia students traveling overseas to take coursework and earn credits at another institution) ☐Columbia-owned program ☐Non-Columbia owned program </p><p>☐ A Joint degree program (defined as Columbia plus an external educational institution, domestic or international, collaborating in a program that leads to the awarding of 2 degrees)</p><p>☐ A “shared” degree program (defined as a program across 2 or more institutions leading to the awarding of ONE degree collaboratively by the multiple institutions)</p><p>☐ A student exchange program, defined as agreements whereby students move from one institution to another, with 3 sub-types: ☐External students come to study at Columbia ☐Columbia students travel to the partner institution to study ☐Students move in both directions</p><p>☐ A clinical placement , defined as field placements for students in program in Nursing, Social Work, OT, PT, Dental, and P&S</p><p>☐ Other internship, defined as field placements for students in non-clinical disciplines, such as Public Health, Arts, SIPA, Journalism, or Law</p><p>☐ Articulation agreement, defined as a type of joint program combining two degrees (majors) from two different institutions, with multiple options for majors at each partner</p><p>☐ A handshake agreement, defined as a statement of general interest in pursuing research and/or educational collaboration in the future, without any specific details</p><p>☐Work Study</p><p>☐Summer/high school program</p><p>☐Executive (non-credit) educational program</p><p>☐ Other – please describe:</p><p>Check is this is a renewal of ☐ Renewal of existing agreement an existing agreement:</p><p>Will this agreement be Primary language: executed in more than one language? If so, please Secondary language: indicate primary and secondary language(s). Estimated number of Graduate students: students involved annually: Undergraduate students:</p><p>Page | 3 version 2017.03.16 Approval of the School Dean or Center/Institute ______Director, as well the Signature of School Dean or Signature of Education Dean Education Dean for each CU Center/Institute Director school/center/institute ______involved (signatures confirm Print Name (IN BLOCK LETTERS) Print Name (IN BLOCK LETTERS) that this proposal has been Date: Date: discussed with and agreed School/Dept: School/Dept: to by the chairs of all participating departments in each unit) ______Signature of School Dean or Signature of Education Dean Center/Institute Director</p><p>______Print Name (IN BLOCK LETTERS) Print Name (IN BLOCK LETTERS) Date: Date: School/Dept: School/Dept:</p><p>______Signature of School Dean or Signature of Education Dean Center/Institute Director</p><p>______Print Name (IN BLOCK LETTERS) Print Name (IN BLOCK LETTERS) Date: Date: School/Dept: School/Dept:</p><p>Please submit the form via email to [email protected]. You may also write to this address if you have any questions about the form or the process. </p><p>Page | 4 version 2017.03.16</p>