Student Admission Application

Student Admission Application

Applicant Information

Applicant Name:

Date of Birth:    Student ID (if assigned):

Home Phone:    Mobile Phone:

Parent / Guardian Information (if applicant is a minor)

Parent/Guardian Name:

Relationship to Applicant:    Phone:

Program & Enrollment

Program Applying For:

Desired Start Date:    Grade/Year Level:

Full-time    Part-time    Remote / Online

Financial Information

Estimated Tuition and Fees (annual): $

Applicant is applying for financial assistance or scholarship    Requesting scholarship consideration

Prior Education

Last Date of Attendance:    Official Transcript Provided:

Medical & Emergency Information

Emergency Contact Name:    Relationship:

Emergency Contact Phone:

Immunization Records Provided:    Medical Authorization on File:

Required Documentation Checklist

Birth Certificate or Proof of Identity    Proof of Residency    Immunization Records

Authorization to Request Official Transcripts from prior institutions

Acknowledgments, Authorizations, and Policies

Enrollment and Admission Records: I certify that all information submitted on this application and in accompanying documents is true, complete and correct to the best of my knowledge. Submission of false or misleading information may subject the applicant to denial of admission or revocation of enrollment. By signing below I authorize the institution to verify any information contained herein, including contacting prior schools and third parties for verification.

Release of Records: I authorize prior educational institutions to release academic records, disciplinary records, and health records necessary to process this application and for official retention in the student's file. This release is for admission and enrollment purposes only and remains valid while the applicant is enrolled unless revoked in writing.

Emergency Medical Treatment Authorization: In the event of an emergency, I authorize the institution to secure necessary emergency medical treatment for the applicant. I understand I will be notified as soon as practicable and that I am responsible for all costs of such treatment.

Financial Responsibility: The person or entity signing below accepts financial responsibility for tuition, fees, and other charges associated with enrollment. Failure to meet financial obligations may result in withholding of records, denial of future enrollment, and referral to collection.

Non-Discrimination: The institution admits students of any race, color, national and ethnic origin, religion, sex, gender identity, sexual orientation, and disability to all rights, privileges, programs, and activities generally accorded or made available to students.

I have read and agree to comply with the institution's academic policies, code of conduct, attendance requirements, and disciplinary procedures as applicable to my enrollment.

I consent to the limited use of photographs or educational recordings of the applicant for institutional purposes.    I consent to the release of directory information as permitted by institutional policy.

Applicant Statement

Certification: I certify under penalty of perjury that the information provided on this application and any attachments is true, complete and correct. I understand that withholding relevant information or providing false information is grounds for refusal of admission or subsequent dismissal. I further acknowledge that acceptance is contingent upon verification of submitted documentation and successful completion of any required clearance procedures.

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