By typing your name and submitting this form, you are agreeing to the following terms and conditions for participation in the Healthcare Academy:

1. Follow the rules of Fond du Lac Public Schools as specified in the Student Handbook.
2. Meet the expectations of each class by participating in daily activities including completing homework and lab assignments, listening attentively, offering relevant comments, posing insightful questions, taking notes and doing any other activities necessary to meet the expectations set forth in each class.
3. Submit high quality work at deadlines and seek additional assistance from instructors as needed.
4. Maintain a B or better in the course sequence work, as a B or higher is required on the MPTC grading scale to receive credit towards the MPTC program.

5. Exemplify the highest degree of academic and personal integrity. Cheating and repeated class disruptions may be grounds for dismissal from the program.
6. Exert concerted effort to schedule recreational trips and all appointments (such as medical and dental) outside of the school day.
7. Remain in the program unless released by the recommendation of the program coordinator and the Academic Review Committee. Motivation, attitude, and progress will determine continued involvement in the program.

I understand that if I do not meet the standards of the HCA program, either because of the quality of my work or because of my performance as a serious learner, I may be asked to withdraw from the program.

I certify that the facts contained in this application are true and complete to the best of my knowledge and that this applicant has not been adjudged for behavior that would constitute a violation of criminal law in an adult court.