Student Program Application

STUDENT PROGRAM APPLICATION

Institution Name:     Application Date:

Applicant Information

Date of Birth:     Student ID:

Applicant is 18 years of age or older:     If not, provide primary parent/guardian contact below.

Parent / Guardian Information (if applicant is a minor)

Program Selection

Desired start date:

Enrollment type: Full-time Part-time     Consideration for scholarship / financial aid:

Education History

Dates attended: From   To

Emergency Contact & Medical Information

Relation:    Phone:

IEP or 504 plan in effect:     IEP/504 documentation attached:

Supporting Documents & Personal Statement

Documents provided with this application:
Official transcript    Immunization record    Copy of ID
Recommendation letters    Personal essay (below)

Fees, Deposit & Payment Agreement

Program fee (total): $     Required deposit: $

Payment plan selection: Pay in full Installments Third-party/financial aid

By submitting this application and signing below the applicant (or parent/guardian if applicant is a minor) agrees that the deposit is non-refundable except as provided in the refund policy below, and authorizes the institution to apply the deposit toward tuition upon enrollment. The institution may cancel acceptance for material misstatement or omission.

Refund policy summary

Application fee is non-refundable. Deposit will be credited to tuition upon enrollment. Withdrawal prior to the program start date may entitle the applicant to a partial refund of the deposit according to the institution's published schedule; withdrawals after the program commencement are subject to the institution's tuition and refund rules. The institution reserves the right to modify refund terms in extraordinary circumstances, subject to written notice.

Consent, Authorization & Acknowledgments

Certification of accuracy: I certify that the information provided in this application is true, correct and complete to the best of my knowledge. I understand that falsification or omission of material information may result in denial of admission or subsequent dismissal.

Authorization to obtain records: I authorize the release of academic, disciplinary and health records as necessary for admission review and enrollment. I authorize previous schools and relevant agencies to release records and information requested by the institution for the purpose of evaluating this application.

Emergency medical authorization: If I (or my child) require emergency medical treatment while participating in institution-related activities, I authorize institution representatives to obtain necessary emergency medical care and to consent to treatment on my behalf when attempts to reach the emergency contact have been unsuccessful. I agree to be financially responsible for medical expenses incurred.

Education records and release: I understand that the institution maintains education records and will protect them in accordance with applicable law. I give consent for the institution to disclose directory information or educational records to third parties when required for legitimate educational interests, placements, or as authorized by law.

Media release (optional): I authorize the institution to use photographs, video, or audio of the applicant for legitimate institutional purposes, including but not limited to publicity, promotional materials, and digital media. I understand that I may opt out by indicating below.
Opt-out of media release:

Non-discrimination: The institution admits students and administers its programs without unlawful discrimination. Applicants acknowledge the institution's policies and agree to abide by institutional rules, codes of conduct, and program-specific regulations.

Acknowledgment: I acknowledge that acceptance into the requested program is conditional upon completion of all admission requirements and receipt of required documentation and fees. I accept responsibility for providing truthful information and timely documentation.

Agreement to terms: By signing below, I agree to the statements, consents and authorizations contained in this application and certify that I understand the refund and payment obligations described above.

Acknowledgment Checkboxes

I certify that the information provided is accurate.
I have read and agree to abide by the institution's policies, code of conduct, and refund terms.
I authorize emergency medical treatment as described above.

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