Educational Institution Policy Acknowledgement Form
Please review the institution’s policies and acknowledge your understanding and agreement below.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Role at the Institution
*
Please Select
Student
Parent/Guardian
Faculty/Staff
Administrator
Other
Department, Grade, or Program
*
Have you received and reviewed the institution’s policy document(s)?
*
Yes, I have received and reviewed the policies.
No, I have not received the policies (please contact administration).
Upload Signed Policy Document (if required)
Upload a File
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Choose a file
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Do you have any questions or comments regarding the policies?
Signature (Please sign below to confirm your acknowledgement)
*
Submit Acknowledgement
Submit Acknowledgement
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