Enrollment Application Form

ENROLLMENT APPLICATION FORM

School Name:    Application Date:

Student Information

Date of Birth:    Student ID (if known):

Primary Phone:    Email:

Parent / Guardian Information (If student is under 18)

Relationship to Student:    Is Primary Contact:

Emergency & Medical Information

Emergency Contact Name:    Relationship:

Emergency Contact Phone:    Alternate Phone:

Previous School / Records

Last Grade Completed:    Reason for Leaving:

I authorize release of academic, attendance and health records from the prior school to the enrolling institution:

Required Documents (check all provided)

Birth Certificate     Proof of Residency     Immunization Record

Transcript / Academic Records     Custody Papers (if applicable)

Enrollment & Financial Agreement

Enrollment Type:    Full-time    Part-time

Proposed Start Date:    Anticipated Completion / Graduation:

Payment Plan Selection:    Annual    Per Semester    Monthly Installments

The undersigned accepts financial responsibility for tuition, fees and other charges incurred while enrolled. The institution's standard refund and withdrawal policies apply. By checking the box below the undersigned acknowledges understanding and acceptance of the financial policies and authorizes processing of payments as indicated.

Acknowledgement of Financial Responsibility:

Policies, Consents and Authorizations

Admission is conditioned upon verification of submitted documents and satisfactory review of prior school records. The institution reserves the right to rescind admission if records are incomplete or inconsistent with the information provided in this application.

Immunization: State and local law require proof of immunization as a condition of enrollment. The undersigned certifies that required immunization records will be provided prior to the first day of attendance. Failure to provide required records may result in exclusion from attendance until compliance is achieved.

Release of Records: By signing below, the undersigned authorizes the release and exchange of academic, disciplinary and health records between the prior school(s) and the enrolling institution for purposes of enrollment, placement and health compliance.

Photo and Media Release: I grant the institution permission to use photographs or video of the student for official school publications, promotional materials and educational purposes, unless I indicate otherwise by checking the box below.    I do NOT consent to photo/media use

Emergency Medical Authorization: In the event of an emergency in which the parent/guardian cannot be reached, I authorize school officials to seek and provide emergency medical treatment for the student, including transportation to a medical facility, and to share necessary medical information with treating providers.   

Additional Information

Certification: I certify under penalty of perjury that the information provided on this application is true and correct to the best of my knowledge. I understand that false statements or omissions may be grounds for denial or revocation of enrollment. I agree to comply with school policies and to notify the school promptly of any changes to the information provided.

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