The State of New York
THE STATE EDUCATION DEPARTMENT
NOTICE OF APPEARANCE

Section 166 of the Executive Law requires a regulatory agency to maintain for public inspection, a record of who appears before it for a fee as a third party (i.e., an attorney, agent, lobbyist, or representative) on behalf of a person or organization subject to the regulatory jurisdiction of the agency. This usually occurs when the third party's client is involved in an enforcement, formal permit, or application matter. This form is subject to all the rules and regulations of the Freedom of Information Law. Information that is confidential as matter of law need not be furnished.

This form is to be completed by any person appearing before the State Education Department in such a representative capacity, and given to the SED staff person before whom he/she is appearing.

Please print clearly:
AGENCY		DATE
DIVISION/BUREAU
1. NAME OF INDIVIDUAL APPEARING
ADDRESS	TELEPHONE
2. CLIENT REPRESENTED
ADDRESS	TELEPHONE
3. SUBJECT OF APPEARANCE REGULATORY/ENFORCEMENT LOBBYING
4. ACTING IN CAPACITY OF ATTORNEY LOBBYIST * AGENT OTHER (describe)
5. ARE YOU BEING COMPENSATED? YES NO	If Yes Fee Salary
6. _________________________________________________________________ Signature of individual appearing
7. _______________________________________________ Print name of agency official ___________________________________ Signature of agency official

*A LOBBYIST is a person or organization, other than a New York State government employee acting in an official capacity, who appears for the purpose of influencing the adoption or rejection of proposed rules, regulations, rates or legislation, including the State budget. An "appearance," for lobbying purposes, can be a personal visit, letter, telephone call, conversation at a meeting, or any other type of contact, but does not include "on the record" proceedings or hearings.

SED Staff Members: Return this form to the Office of the Legislative Coordinator,
Room 118 Main Education Building

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