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N APPLICATION T HE NATIONAL EXTERNAL DIPLOMA PROGRAM (New York State Education Department)

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N APPLICATION
The University of the State of New York
THE STATE EDUCATION DEPARTMENT
High School Equivalency (HSE) Office
89 Washington Avenue, EBA 460, Albany, NY 12234
518-474-5906
T
HE NATIONAL EXTERNAL DIPLOMA PROGRAM (NEDP)
Application for the New York State High School Equivalency Diploma
If not using fillable form, please print clearly in blue or black ink.
Agency Rec
ommending Diploma and Transcript
6-Digit Agency Code: Agency Name:
Street Address:
City: State: Zip Code:
Lead NEDP Contact Name: Lead NEDP Contact Phone Number: ( )
Lead NEDP Email Address: Alternative Phone Number: ( )
Applicant Information
Have you ever taken the 2002-2013 GED® test or the 2014-present TASC™ test in New York State? Yes No
CASAS Student ID: N Date of Birth:
Last Name: First Name: Middle Initial:
Street Address: Apt. City: Zip:
Social Security Number: OR Other Gov’t ID
Gender: Male Female
Applicant Signature and Certification (In blue ink)
I understand that my eligibility for completing the NEDP was based on the information I provided the Agency at the time I
enrolled in the program, information contained in this application, and in any other documentation I provided the Agency or
the NYSED regarding my eligibility to participate in the NEDP program. I certify that I do not hold a high school diploma or
HSE diploma recognized in the United States and have lived in New York State for at least 30 days. I certify that the
information included with this application and any other attachment I provided to the Agency or to NYSED was complete and
accurate to the best of my knowledge and belief. I further agree that if it is determined that I intentionally gave false
information, my application and/or diploma can be rescinded.
Applicant Signature _______________________________________________________________ Date _____/_____/______
mm dd yyyy
NEDP Approved Agency Signature
NEDP Program Manager Signature:
Name:
Telephone Number:
( )
Email:
Date:
/ /
In blue ink
Verified Client Status Report
Verified Portfolio Review Form
mm dd yyyy
COMPLETE APPLICATION AS DIRECTED AND MAIL TO HSE OFFICE AT ADDRESS NOTED ABOVE.
The New York State High School Equiv
alency (HSE) diploma, earned through NEDP, is awarded to applicants who have
successfully completed the ten (10) competency areas at a New York State Education Department (NYSED) approved
NEDP agency and who meet residency and age eligibility requirements.
02/04/2020
ATTACHMENT N
THE NATIONAL EXTERNAL DIPLOMA PROGRAM (NEDP)
APPLICATION FOR THE NEW YORK STATE HIGH SCHOOL EQUIVALENCY DIPLOMA
1. Gener
al Information
Program completers who meet all requirements of the National External Diploma Program (NEDP) must submit an Attachment N*
signed by their New York State (NYS) NEDP Approved Agency Program Manager. Once the completed Attachment N is received by
the New York State Education Department (NYSED) High School Equivalency (HSE) Office, NEDP program completers will receive a
NYS High School Equivalency Diploma.
2. Eligibility Requirements
All candidates for the NYS HSE Diploma based on the NEDP must be at least 18 years of age, have lived in New York State for at least
30 days and must not have already earned a high school diploma or a NYS HSE Diploma.
3. To Apply
The NYS NEDP Approved Agency and the NEDP program completer who meets all the eligibility requirements must follow the steps
listed below to obtain a NYS HSE Diploma. Complete all information on Attachment N (all fields must be completed). Print legibly.
Agency Recommending Diploma and Transcript:
Enter the 6-Digit Agency Code as assigned by the Comprehensive Adult Student Assessment Systems (CASAS).
Enter the official NYS NEDP Approved Agency name and address.
Enter the Lead NEDP Contact Name, email address and phone numbers.
Note: The Lead NEDP Contact is not always the same individual as the Program Manager for the NYS NEDP Approved Agency.
Applicant Information/Program Completer:
Enter your CASAS Student ID (begins with “N”). If unknown, ask the agency.
Enter your legal name. Do not use nicknames, alias or abbreviated names. The legal name will appear on your NYS HSE
diploma. Using names other than your legal name may result in delays to receipt of your HSE diploma and inaccurate records.
Enter your official mailing address. This is the address to which your HSE diploma will be mailed.
Enter your Social Security number or other government ID.
Applicant Signature and Certification:
Read, sign and date, using month, day, year format, the Certification in blue ink.
NEDP Approved Agency Signature:
The NYS NEDP Approved Agency Program Manager (the overall administrator of the NEDP program) signs the application in
blue ink. By signing, the Program Manager certifies that the applicant has demonstrated the competencies necessary to
complete the NEDP as verified through Portfolio Review Form and the Client Status Report. Also provide phone, email and
date, using month, day, and year format.
4. Mail the completed Attachment N to:
New York State Education Department
High School Equivalency (HSE) Office
89 Wash
ington Avenue, EBA 460
Albany, New
York, 12234
Note: Do not mail the NEDP Client Status Report and/or the Portfolio Review Form to NYSED. Retain a copy of Attachment N
for the program completer’s record.
5. Additional Transcripts
The first NYS HSE Diploma is provided at no cost to the program completer. After the NYS HSE Diploma has been awarded,
duplicates diplomas may be obtained by submitting an Attachment H* to the address listed above. A nonrefundable fee of $10.00 will
be charged for each diploma requested.
*Attachments may be found here.
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N APPLICATION T HE NATIONAL EXTERNAL DIPLOMA PROGRAM (New York State Education Department)

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Completed 5 October 2020

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