Student Admission Document

STUDENT ADMISSION DOCUMENT

Applicant Information

Student Name:

Date of Birth:    Student ID (if known):

Program and Academic Information

Program Applied For:

Grade / Level:    Proposed Start Date:    Expected Graduation:

Official transcripts provided: Yes     Immunization records provided: Yes     Special education services: Yes

Emergency & Medical Information

Primary Care Physician:    Phone:

Financial Responsibility & Tuition

Total Tuition (annual): $    Enrollment Deposit: $

Payment Plan (select one): Paid in full Semester installments Monthly installments Other

Required Documents Checklist

Birth certificate or legal proof of age

Official transcripts

Immunization records

Proof of residency / guardianship documents

Acknowledgements and Consents

By signing this document, Applicant or Parent/Guardian acknowledges that all information provided is true, complete and accurate to the best of their knowledge. Falsification, omission, or misrepresentation of any material fact may result in admission revocation. Initials:

Applicant/Parent/Guardian understands that admission is conditional until all required records have been verified and that the institution may place a hold on enrollment or withdraw admission if documentation is not received in a timely manner. Initials:

Consent for emergency medical treatment: In the event of an emergency, I authorize the institution to obtain emergency medical care for the student and to disclose necessary medical information to medical personnel. I understand I am financially responsible for treatment. Initials:

Educational records: I acknowledge that the institution maintains student records and that access to those records will be governed by institutional policy. I authorize release of records to previous schools for verification purposes as necessary for admission. Initials:

Tuition obligation: By enrolling, the Billing Responsible Party accepts financial responsibility for all tuition and fees assessed, including applicable penalties for late payment or withdrawal according to the institution's published tuition policy. Initials:

Certification

I certify under penalty of perjury that the information provided in this Student Admission Document is true, accurate and complete. I further authorize the institution to contact previous schools, healthcare providers, and other entities as necessary to verify information supplied herein. I understand that this document creates a binding obligation for tuition and fees as indicated above and that institutional policies govern refund, withdrawal, and disciplinary procedures.

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