Course Enrollment Checklist

COURSE ENROLLMENT CHECKLIST

Student Information

Date of Birth:    Student ID:    Grade / Program:

Parent / Guardian (if applicable)

Course Selection

Term:    Start Date:

Complete the desired courses below. Student acknowledges responsibility to meet prerequisites and to adhere to schedule.

Documentation Submitted

The following documents are submitted with this checklist (check all that apply):

Official transcript(s)    Immunization record    Photo ID    Proof of residency

Accommodation request documentation (if applicable)    Other:

Prerequisite & Eligibility Certification

By checking the boxes below, the student or guardian certifies that all stated prerequisites and eligibility requirements for the selected courses have been met or that appropriate documentation is attached. Misrepresentation or omission of records may result in withdrawal from enrollment.

I attest prerequisites are complete or approved by an academic advisor.
Supporting documentation for prerequisites is attached or on file.
Student is in required academic standing to enroll in requested courses.

Schedule & Conflicts

Will any selected course create a schedule conflict with the student’s current commitments (work, other courses, clinical placements, etc.)?    Yes    No

Tuition, Fees & Payment

Total Estimated Tuition and Fees for selected courses: $

Payment arrangement (select one):
Full payment at registration    Installment plan    Financial aid / scholarship pending

Student understands and agrees that tuition and fee obligations are binding upon enrollment and that the institution’s published refund and withdrawal policies apply. Documentation provided on this checklist may be relied upon for enrollment and billing purposes.

Academic Policies Acknowledgment

By signing below, the undersigned acknowledges having read and understood the institution’s academic policies applicable to course enrollment, attendance, grading, withdrawals, and academic integrity. The undersigned further acknowledges that falsification of information may result in denial of enrollment or other disciplinary action.

I acknowledge and agree to the academic policies and enrollment terms stated above.

Consent to Release / Privacy

The undersigned authorizes the release of academic records and enrollment information to designated parties as required for academic advising, financial aid processing, and mandated reporting. The institution will handle records in accordance with applicable privacy and education records law.

I consent to release of records as described above.

Certification

I certify that the information provided on this Course Enrollment Checklist is true, complete, and accurate to the best of my knowledge. I understand that I am responsible for any fees incurred as a result of this enrollment and that failure to comply with institutional policies may result in administrative action. I authorize verification of submitted documentation and acknowledge that intentional misrepresentation of facts may constitute cause for disciplinary action.

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