Licensure Disclosure Form | Office of the Provost

Licensure Disclosure Update Form

School *

Name (Designated school point person) *

Please confirm that the following direct licensure disclosures have been made, or are being made as admissions cycles continue, and that your school can provide documentation if audited.

Prior to enrollment if (B) or (C) in Section I of the WashU Licensure Disclosure Policy are true. *

YES

If your school later determines a program falls into (C) in Section 1 of the WashU Licensure Disclosure Policy, currently enrolled students are notified within 14 calendar days of making the determination. *

YES

When your school/program is notified by the Registrar that a student has formally changed their “Home” address in SIS to another State, your school/program notifies that student within 14 days if the program falls into (B) or (C) of the WashU Licensure Disclosure Policy. *

YES

Provide contact information for State licensing board when no determination is made (SARA manual, section 5.2). *

YES

If you answered "No" to any of the above, please explain.

Please list your school's weblinks to all “make available” licensure disclosures. (i.e. Admissions information)

Website/URL

Add Remove

Please upload the following documents using the naming format at the end of this form.

All programs leading to licensure/certification subject to the WashU Licensure Disclosure Policy.

Maximum file size: 104.86MB

Templates of direct disclosure message(s) (i.e. emails).

Maximum file size: 104.86MB

Document naming format (for auditing purposes)

List of all programs leading to licensure/certification subject to the WashU Licensure Disclosure Policy.
Upload file named: “year_all programs list_school”
Example: “2022_all programs list_McKelvey”

Templates of direct disclosure message(s):
Upload file(s) named: “year_disclosure message_number_school”
Example: “2022_disclosure message 1_McKelvey”

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