New Student Application

Application Fee

By filling out and submitting this application, I understand the non-refundable application fee of $125 must be paid, in full, before my application will be considered. Acceptable payments are by check or by paypal to alisha@31Institute.

Name *

First

Middle

Last

Email *

Email

Confirm Email

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Emergency Contact

Name *

First

Last

Relationship to applicant *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Universities that are recipients of federal dollars are required by the Federal government to solicit certain demographic information to meet federal reporting requirements. Applications are requested to provide the following information voluntarily. This information will not be utilized in a discriminatory manner.

Nation of Citizenship

Race / Origin

Native Language *

Gender *

Are you a veteran of the U.S. Military? *

Date / Time *

If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any risk of disciplinary action or revocation of your offer of admission.

Are you currently or have you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution? *

Yes
No

If yes, please explain

Have you ever been charged with a violation of the law which resulted in, or if still pending could result in, probation, community service, a jail sentence, or the revocation or suspension of your driver’s license (including traffic violations which resulted in a fine of $200 or more?) *

Yes
No

If yes, please explain

High School Information

High School Name *

Please provide two personal or professional references.

Name *

First

Last

Phone *

Relationship *

Phone *

Name *

First

Last

Relationship *

Agreement

I understand that this application is for admission only for the term indicated. I agree that I am bound by 31 Institute LLC’s regulations concerning application deadlines and admission requirements. I agree to the release of any transcripts and test scores to this institution, including any SAT, Achievement Test, and ACT score reports. I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or residency statement will result in disciplinary action, denial of admission and invalidation of credit or degrees earned. If admitted, I agree to abide by the policies, rules, and regulations of 31 Institute, LLC. Should any information change prior to my entry into the school, I will notify the Office of Admissions. I understand that the application fee I submit with this application is a non-refundable fee. I also certify that I have been provided with a copy of, and read, the Texas Notice of Potential Ineligibility for License.

Texas Notice of Potential Ineligibility for License

NOTICE OF POTENTIAL INELIGIBILITY FOR LICENSE Texas law: • restricts the issuance of occupational licenses based on a license applicant’s criminal history; and • authorizes the Texas Department of Licensing and Regulation (TDLR), in some cases, to consider a person convicted, even though the person was only on probation or community supervision without a conviction. As an applicant/enrollee in an educational or training program that prepares individuals for issuance of an occupational license, I have been provided with notice by 31 Institute, LLC of the following: • If I have been convicted of an offense or placed on probation, I might not be eligible for an occupational license issued by TDLR after I complete this educational or training program; TDLR’s criminal history guidelines are available at www.tdlr.texas.gov/crimconvict.htm and include restrictions or guidelines TDLR uses to determine eligibility for an occupational license; and • I have the right to request a criminal history evaluation letter from TDLR, which is explained in more detail at www.tdlr.texas.gov/crimhistoryeval.htm. Section 53.152, Occupations Code, requires that notice be provided to each applicant and enrollee regardless of whether the applicant or enrollee has been convicted of an offense. REFUND AND ORDERED PAYMENTS. State law requires TDLR to order an educational program provider to refund tuition, license application fees, and examination fees if: • TDLR determines the provider failed to provide notice to me; and • my license application was denied because of my criminal history.

Do you understand and agree to the terms listed above? *

Yes, I understand and agree to the terms listed above.