A program with pre-accreditation status has submitted an application which is predicated on its relationship to a particular sponsoring institution that has also applied for ACGME accreditation. The designated institutional official (DIO) of that institution has explicitly agreed that the institution is willing and able to provide the necessary institutional support for the program. If the program then chooses to move to another sponsoring institution, it must have similar support from the DIO of that other institution. The program must withdraw its original application, and the DIO of the second institution must then initiate the process for the program to submit a new application, based on its relationship to that second institution. Under other circumstances, such a change would require the program to submit a second new program application fee. In the spirit of the MOU, the ACGME has determined that if it is clear that the same program has submitted a second application due to a change in sponsoring institution (i.e., by AOA program number), payment of a second application fee will not be required.