Student MN Form

STUDENT MN FORM

Student Information

Date of Birth:    Student ID:    Grade / Program:

Primary Phone:    Email:

Parent / Guardian (if applicable)

Relationship to Student:    Phone:    Email:

Is the student 18 years of age or older? Yes

Program Enrollment & Financial Responsibility

Program Start Date:    Anticipated Completion Date:

Payment Plan Options (select all that apply):
Full payment due prior to program start    Installment plan (enrollment required)    Scholarship / Financial aid applied

The undersigned acknowledges financial responsibility for tuition, fees, and any charges incurred. Failure to pay may result in withholding of academic records, assessment of late fees, and referral to collections. Refunds for withdrawal are governed by the program's published withdrawal and refund schedule; disputes will be resolved under the institution's standard administrative process.

Emergency Contact & Medical Information

Relationship:    Phone:

Immunizations up to date: Yes    If no or partial, explain:

Consent, Authorizations & Academic Policies

Emergency Medical Treatment Authorization: In the event of an emergency where the undersigned cannot be reached, I authorize school personnel to seek and authorize emergency medical treatment for the student. I understand I am responsible for all costs associated with such treatment.

Medication Administration: I authorize school personnel to administer medications listed above in accordance with written instructions provided. Parent/guardian will supply medication in its original labeled container and a signed medication authorization form when required.

Academic Records and Student Information: I authorize the release and exchange of educational records, transcripts, and health information between the institution and other educational entities as necessary to provide services and maintain accurate records. The institution will maintain confidentiality consistent with applicable record-keeping practices.

Code of Conduct and Attendance: I acknowledge that the student must comply with the institution's code of conduct, attendance policies, and academic standards. Noncompliance may result in disciplinary action, interruption of participation, or dismissal from program.

Photo and Media Release: I grant permission for the institution to photograph or record the student for use in educational materials, promotional materials, and internal communications unless I indicate otherwise by checking below.
I do NOT consent to use of the student's image or likeness

Transportation and Field Trips: I authorize the student to participate in institution-sponsored transportation and field trips. I understand separate notices will be provided for specific off-campus events and additional consent may be required for certain activities.
I DO consent to field trips and off-campus activities

Acknowledgment and Certification

By signing below, I certify that the information provided on this form is true, accurate, and complete to the best of my knowledge. I understand that providing false information may result in denial of enrollment or disciplinary action. I accept responsibility for payment of tuition and fees and agree to comply with program policies. I further authorize the institution to take reasonable actions necessary in the event of an emergency and understand the limits of the institution's liability.

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