Student Digital Application

Student Digital Application

Student Information

Student Name:   Preferred Name:

Date of Birth:   Student ID (if assigned):

Enrollment Details

Program of Interest (select one or more):

Undergraduate Graduate Certificate Non-credit / Continuing Education

Enrollment Status:    Full-time Part-time

Payment Plan Preference:    Pay in full Installment plan Financial aid/scholarship

Prior Education

Degree or Diploma:   Graduation Date:   Cumulative GPA:

Emergency & Health Information

Primary Physician:   Phone:

Health Insurance Provided: Yes   Policy/Carrier:

Supporting Documents

Please indicate and attach required documents where available:

Official transcript Government-issued photo ID Immunization records Proof of residency Personal statement / essay

Academic Policies & Consent

By submitting this application, the undersigned certifies that all information provided is true, complete and correct to the best of their knowledge. The undersigned authorizes the institution to verify academic, residency, and other information submitted in support of this application and to obtain records as necessary to assess eligibility for admission and financial assistance. Knowingly false statements or material omissions may be grounds for denial of admission or rescission of enrollment.

The undersigned further consents to the institution contacting listed references, prior schools, or health care providers for purposes related to enrollment, placement, or safety when necessary. The applicant acknowledges responsibility for tuition and fees assessed in accordance with institutional policy and the payment plan selected. Acceptance of this application does not constitute enrollment until all admission requirements are satisfied and any required deposits are received.

Photo and Work Release: The undersigned grants the institution permission to use photographs, video, or other media that include the student for educational, promotional, or archival purposes without compensation, unless the undersigned indicates otherwise in writing to the admissions office.

Acknowledgement of Policies: I acknowledge and agree to the statements above and to applicable institutional policies.

Applicant Certification

I certify that the information provided in this application is complete and accurate. I understand that the institution may require additional documentation and that failure to provide requested documentation may delay or prevent admission. If the applicant is under 18 years of age, a parent or legal guardian must sign below. Electronic or typed signatures are accepted for the purposes of application processing.

Date of Application:

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