Admissions Application

Admissions Application
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Name of High School
What Year Did You Graduate High School?
E

The Universal College of Healing Arts is committed to maintaining a safe environment for all members of our community. All applicants must answer these questions. An affirmative answer to any of these questions does not automatically bar admission to the institution but does require review. Also, UCHA may request a background report as part of your application process. This report may include details about your character, reputation, personal traits, lifestyle, and credit history. Information sought may cover Social Security verification, criminal, educational, and driving records, prior employment, references, credit reports, drug tests, and workers' compensation records. Credit history will only be considered if relevant to the job. Reports may be sourced from interviews with associates and public records.

The report, conducted by Clear Screening Technologies, LLC, based in Denver, CO, may influence UCHA's decision-making, particularly regarding eligibility for licensure-related offenses. UCHA reserves the right to deny acceptance based on certain convictions, such as pedophilia or sexual assault. For inquiries, contact ClearChecks - Background Checks for Employers at 1-855-253-2763 or visit their website.

Workers' compensation information will only be requested in compliance with the federal Americans with Disabilities Act and any other applicable federal, state, or local laws and only after a conditional job offer is made. Credit history will only be requested when permitted by law and where such information is substantially related to the duties and responsibilities of the position for which you are applying. The information may be obtained from private and public record sources, including personal interviews with your associates, friends, and neighbors. The nature and scope of the investigative consumer report is an investigation into your education or employment history conducted by the Background Check Company or another outside organization.
Have you entered a plea of guilty, a plea of no contest, a plea of nolo contender, an Alford plea to a criminal charge, or a plea under a first offender act?
You have selected yes to the above question, explain including instance and dates.

Right to Use Photographic Likeness or Recording

I grant the Universal College of Healing Arts, its successors and assigns, the right to use and publish for advertising purposes photographic portraits, photographic likenesses, pictures, video recordings or audio recordings of them. I may be included in the whole or in part or reproductions thereof, made through any medium including posting on the website of the Universal College of Healing Arts. I also waive any right that they may have to inspect or approve the finished product or the advertising or other copy that may be used in connection wherewith or the use to which it may be applied. I release and discharge The Universal College of Healing Arts as well as their successors, assigns and all persons acting under their permission or authority, from any liability by virtue of any alteration, blurring, distortion, or use in composite form whether intentional or otherwise, that may occur or be produced in the taking of the pictures, or in any processing, unless it is shown as they and the publication thereof were maliciously caused.
Application Agreeance

After reading and confirming, signing your name in the certification field below as you would sign an official document. I understand that any material false statement made knowingly and willfully by me on this application, or any documents attached hereto may, in accordance with Nebraska Revised Statute 28-915, A person is guilty of perjury if, in any (a) official proceeding he or she makes a false statement under oath or equivalent affirmation, or swears or affirms the truth of a statement previously made, when the statement is material and he or she does not believe it to be true or (b) official proceeding in the State of Nebraska he or she makes a false statement in any unsworn declaration meeting the requirements of the Uniform unsworn Foreign Declarations Act under penalty of perjury when the statement is material and he or she does not believe it to be true. Perjury is a Class III felony.
Signature
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