Student North Form

Student North Form

Student Information

Date of Birth:    Student ID:

Program Start Date:

Primary Phone:    Email:

Parent / Guardian Information (if student is a minor)

Relationship:    Phone:

Enrollment & Program Selection

Intended Program:

Full-time    Part-time    Transfer student

Emergency Contact(s)

Relationship:    Phone:

Relationship:    Phone:

Medical Information & Authorizations

Medical Insurance Provider:    Policy Number:

Emergency Medical Authorization:

I authorize Student North staff and its designated medical agents to obtain emergency medical treatment for the student named on this form if parent/guardian or student (if age 18 or older) cannot be reached. I understand that the school will make reasonable efforts to notify the listed emergency contacts prior to non-emergent treatment. I further understand that decisions regarding treatment will be made in accordance with prevailing medical standards and consistent with the medical information provided on this form.

I consent to emergency medical treatment as described above.

Media, Records & Privacy

Media Release: I grant Student North the right to photograph, record, and use images or recordings of the student for educational, promotional, or archival purposes, subject to the limitations below. I understand this release does not entitle me to compensation.

I consent to media use as described above.    I decline media use for the student.

Student Records Release: Unless otherwise restricted in writing, Student North may disclose directory information for the student to third parties in accordance with institutional policy. To request a restriction on directory information or to authorize release, submit explicit written instructions on school letterhead or by signed letter to the Registrar.

I authorize release of academic information to parents/guardians listed on this form where permitted by policy.

Tuition, Fees & Payment Terms

Tuition for the selected program: $ . Student North assesses fees and tuition in accordance with published schedules. Enrollment is not confirmed until tuition terms are accepted and any required deposit is paid.

Lump-sum payment    Monthly installment plan    Financial assistance / scholarship application pending

Refunds and withdrawals are governed by institutional policy: tuition refunds, if any, will be prorated based on the effective date of withdrawal and may be subject to administrative fees. By enrolling I agree to be responsible for any outstanding tuition and fees assessed under the applicable tuition schedule.

Student Code of Conduct & Attendance

The student agrees to comply with Student North policies regarding conduct, attendance, academic integrity, and campus behavior. Violations may result in disciplinary action including suspension or dismissal. The student and parent/guardian (if applicable) acknowledge receipt of and agreement to abide by these policies.

I acknowledge that I have read and will comply with the Student North Code of Conduct and Attendance Policies.

Certifications, Representations & Acknowledgments

By signing below, I certify that the information provided on this form is true, complete, and accurate to the best of my knowledge. I agree to notify Student North promptly of any changes to the information contained herein. I understand that falsification of information may result in denial of enrollment or disciplinary action.

I acknowledge that Student North collects, maintains, and uses student data in accordance with institutional policies for educational and administrative purposes. I further agree to indemnify and hold harmless Student North and its employees for actions taken in good faith under the authority granted by this form, except for willful misconduct or gross negligence.

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