STUDENT REGISTRATION
©ESSENTIALS
IN VOLUNTEER MANAGEMENT CERTIFICATE PROGRAM OR OPTIONAL NOTRE DAME
COLLEGE
UNDERGRADUATE
THREE-CREDIT
COURSE
______________________________________________/_________________________
Last Name First Name Middle E-mail
________________________________________________________________________
Local Mailing Address City/State/Zip
________________________________________________________________________
Employment Name
________________________________________________________________________
Employment Address
________________________________________________________________________
Home Phone # Cell Phone # Work Phone #
I,
______________________, am
registering as a student in the Essentials
in Volunteer Management Certificate Program or optional Notre Dame
College
Undergraduate Three-Credit Course.
I agree to accept the direction of the instructors and
Certificate Task
Force Committee in all matters relating to the course and to complete
all
registration requirements before the beginning of classes. (See Requirements for
Registration.)
I
am able to perform my
studies in this program___ with___ without ___ accommodations. I declare that all
submitted information is
correct.
I also understand that any false or misleading statement contained in my application for registration may affect my status as a student in the Essentials in Volunteer Management Certificate Program or optional Notre Dame College Undergraduate Three-Credit Course.
________________________________________________________________________
Student Signature Date
All submitted information will be
respected in terms of
privacy and not shared with or disclosed to anyone outside of the
Certificate
Task Force Committee. Selection
for
admission is made without regard to race, creed, sexual orientation,
religion,
color, gender, handicap, age or national origin.
If an emergency contact cannot be reached, Management Systems by Design, Inc. reserves the right to seek medical assistance at the nearest medical facility and will be held harmless in all legal issues which may arise from this decision. Emergency contact: ____________________/number__________
I understand that as a student in Management System by Design, Inc.’s Certificate Program or optional Notre Dame College Undergraduate Three-Credit Course, I may be videotaped, audio taped, interviewed, and/or photographed any time during each class. I agree to allow MSBD to keep as its property the products of such videotaping, audio taping, interviewing, and/or photographing. I agree that such material, along with my name, may be used and posted on the MSBD web site for promoting the program, and in any publications and/or publicity generated by MSBD. No compensation will be paid for such use.
