Background Affidavit

Students with prior criminal background histories may find it more difficult to be successfully employed as Medical Assistants and Early Childhood Education Employees. Students with criminal histories are strongly encouraged to consider their background before enrolling into these programs. In some cases, externship sites may deny students placement for externship to complete their program at the college. Failure to complete externship, leads to the inability to graduate.

Accordingly, we ask all persons interested in Medical Assistant/Early Childhood Education to disclose their complete history of criminal convictions including misdemeanors and felonies as well as to complete and sign the Affidavit below so that College for Technical Education may provide the best assistance possible:

I,Your Name* , am applying for admissions into the College of Technical Education for the * program.

My past criminal history includes the following convictions and approximate dates (if none, write none):*

I attest that the above represents a complete history of my past criminal convictions.*

Signed Date

Your Legal Name*

Your Email Address*

example@example.com

I agree by signing and submitting this form to be legally bound by this agreement.

Signature*