Student Support Services

Instructions for Completing the Application to Offer Course Work or Training in School Violence Prevention and Intervention

Submit completed Applications for Approval, including the fee of $600 made payable to the New York State Education Department to:

New York State Education Department

Student Support Services

Education Building, 318-M

Albany, NY 12234

Chapter 181 of the Laws of 2000 established the requirement that individuals applying for certification as teacher assistants, teachers, pupil personnel services professionals and school administrators after February 2, 2001 must complete two hours of course work or training regarding school violence prevention and intervention.  These instructions outline information required on the Application for Approval as a Provider.  Prior to completing the Application, please read all of the instructions carefully.  Those institutions/organizations which will offer the training to one or more of these audiences must apply to the State Education Department for provider approval.

  • Please list the official name and address, including the county, of the applicant/provider.  The contact person is the individual to whom any questions about the application should be addressed.  The telephone number is the number at which the contact person may be reached during regular business hours.  If the contact information changes, call 518-486-6090 to update the Provider File.
  • Check the appropriate category in which the applicant/provider belongs.  Please note that providers are limited by regulation to the listed categories; applicants from other categories are ineligible.
  • Identify the target audience.  If more than one category is expected to attend the course work or training, please check all that are applicable.
  • Identify the person(s) authorized to electronically transfer the Completion of Coursework for each participant. You need to include the e-mail(s) that will be used to electronically submit the Completion of Coursework. If the certifying officer information changes, call 518-486-6090 to update the Provider File.
  • Identify the location where the Completion of Coursework (could be electronic file) and copies of all program materials used for each presentation will be maintained.  Identify the name, phone number and fax number of the person responsible for maintaining these records.  If this information changes, call 518-486-6090 to update the Provider File.
  • Describe the professional population primarily served by your organization and the scope of services you provide.
  • Indicate the length in hours of the program, the delivery format, any evaluation plans, and any fees charged to participants. Enclose a course syllabus with the application.
  • On the Instructor Qualifications form provided, identify the professionals who will have primary responsibility for program development and delivery.  Provide their academic credentials, relevant experience, and expertise in school violence prevention and intervention.  You may duplicate the form if additional copies are needed.  If instructors are added or deleted, contact 518-486-6090 to update the Provider File.
  • Describe the financial and physical/personnel resources which you expect to utilize in order to offer the course work or training.  Documentation which should be submitted regarding financial resources may include the most recent certified audit, verification of deposits, funding sources (such as government, private, corporate, etc.), or description of other assets.  Physical/personnel resources include classroom/meeting room location, texts and other training materials, technology, equipment, the anticipated number of individuals involved in providing the training, and any other such resources.
  • Include a course outline or syllabus in the application packet.  The course must cover     relevant legislation.


57-2.3. Responsibilities of providers.

(a) Pursuant to the requirements of Education Law section 3004, a provider, at a minimum, shall offer at least two clock hours of course work or training in school violence prevention and intervention.  Such course work or training shall include, but not be limited to:

  1. Study in the warning signs within a developmental and social context that relate to violence and other troubling behaviors in children;
  2. The statutes, regulations and policies relating to a safe nonviolent school climate.  This will minimally include the 2000 SAVE Legislation and 2010 Dignity for All Students Act;
  3. Effective classroom management techniques and other academic supports that promote a nonviolent school climate and enhance learning;
  4. The integration of social and problem solving skill development for students within the regular curriculum;
  5. Intervention techniques designed to address a school violence situation; and,
  6. How to participate in an effective school/community referral process for students exhibiting violent behavior.
  7. Defining, identifying, intervening and ending bullying in all its forms, including cyberbullying. Identifying ways for all stakeholders to become active school community members who share responsibility for school culture and climate and are proactive in promoting civility, acceptance and good citizenship.


  • Application fee of $600 payable to the NYS Education Department.  The Department will accept money orders and certified checks, but cannot process purchase orders or vouchers.  Applications cannot be reviewed without the appropriate fee.
  • Completed Application form, signed by an authorized official, and supporting information.
  • Course Outline or  Syllabus
  • Instructor Qualifications Forms.
  • Signed Provider Agreement.

If you have questions, please contact 518-486-6090

Thank you, Joseph Leffler


 Student Support Services

Education Building, Room 318-M

Albany, NY  12234

Last Updated: May 9, 2018