I met with Senior Investigator _______ of the Office of Professional Discipline, (street)_______, (city)_______, New York (zip code)_______ on _______. The Investigator has furnished me with copies of the New York State Education Law, Title 8, Subarticle 4, Section 6512, Unauthorized Practice A Crime, and Section 6513, Unauthorized Use Of A Professional Title A Crime.
I understand that your office has conducted an investigation relating to myself and/or my place of business concerning the practice of _______. I have been advised that the aforementioned sections of law may have been violated in that (describe conduct) ____________________________.
I declare that I will cease any actions, which may have been violative of the New York State Education Law cited above, and will in the future comply with all provisions of that law.
I further declare that this agreement is subject to public disclosure, and I am waiving any personal or statutory right of confidentiality relating to the release of this document, or the information contained herein. I understand that the Office of the Attorney General will be apprised of this agreement, and that subsequent complaints of illegal practice of any of the professions by me may be referred to the Office of the Attorney General for criminal prosecution.