Educational Pathways TI Form

EDUCATIONAL PATHWAYS TI FORM

Student Name:    Date of Birth:    Student ID:

Grade / Program:    School Year:

Program Enrollment Details

Select Pathway (check all that apply):

Internship Apprenticeship Technical Instruction Work-Based Learning

Academic & Eligibility Information

Special Education / 504 Plan: Yes No

Transportation, Fees & Compensation

Transportation Provided By: District Family/Student Public Transit

Emergency Contact & Medical Information

Consent, Release & Certifications

By signing this form I certify that the information provided is complete and accurate. I authorize the school district and the training provider to share educational records, attendance, and placement evaluations necessary for participation in the Educational Pathways program. I understand that participation requires compliance with all applicable school policies and the site-specific rules of the training employer.

Release and Liability: Except for willful misconduct or gross negligence, I release the school district, its agents, and the training provider from liability for claims arising from my (or my child's) participation in the program. I authorize emergency medical treatment if necessary and agree to be responsible for medical expenses not covered by insurance.

Background Checks & Drug Screening: Some placements require criminal background checks and/or drug screening. I consent to such screenings when required as a condition of placement and understand that a disqualifying result may prevent placement.

Records Release Acknowledgment: I consent to release records to the training site and related program partners.

Background Check Consent: I consent to required background checks as a condition of placement.

Drug Testing Consent: I consent to drug testing when required by the placement site.

Parent / Guardian Information (If Student Is Minor)

Academic Policies Acknowledgment

I acknowledge that program credit, grading, and attendance policies are governed by the sending school and the training provider. Failure to meet attendance, conduct, or performance standards may result in removal from the placement and forfeiture of program credit.

Withdrawal & Refunds: If fees or tuition are assessed, withdrawal procedures and refund eligibility are governed by the policies described under Tuition or Fees Responsibility above. I understand financial obligations remain until formally withdrawn according to program procedures.

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