Student Curriculum Application

STUDENT CURRICULUM APPLICATION

Applicant Information

Program Selection

Anticipated start date:

Full-time    Part-time    Audit

Academic Background

Official transcript submitted:    Yes    To follow

Curriculum Plan

Eligibility and Prerequisites

I affirm that I meet the stated prerequisites for the selected curriculum:

Required prerequisite courses completed    Minimum GPA requirement met    Placement test requirement satisfied

Accommodations and Medical Information

Does the applicant require academic accommodations?    Yes    No

Supporting Documents

Documents submitted with this application:

Official transcript    Test scores / placement    Personal essay    Recommendation letters    Portfolio / work samples

Policies, Authorizations, and Certification

By submitting this application, I certify that the information provided on this form and in all supporting documents is true, complete, and accurate to the best of my knowledge. I understand that knowingly providing false information is grounds for denial of admission or subsequent dismissal if discovered after enrollment.

I authorize the release of my academic records, test scores, and other relevant documentation from prior institutions for the purpose of evaluation for admission and placement. I further authorize the institution to verify any information provided and to request additional documentation where necessary.

I acknowledge that acceptance into the selected curriculum is contingent upon verification of records, meeting prerequisites, and any required clearances. I understand that course scheduling, program availability, and tuition/fee assessments are subject to institutional policies and may affect my enrollment status.

In the event of an emergency, I consent to necessary medical treatment for the applicant and release the institution and its representatives from liability for actions taken in good faith to provide such care, except where prohibited by law.

Acknowledgements (initial each):    Initials: Academic policies, attendance, and integrity    Fees and tuition obligations

Consent to data use: I consent to the institutional use of my application data for enrollment processing, academic advising, and statistical reporting in accordance with institutional privacy practices. I understand that third-party disclosures will be made only as authorized or required by law.

Applicant Status and Parent / Guardian Information

Is the applicant under 18 years of age?    Yes    No

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