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Attestation Form

Northeast is committed to complying with federal regulations and demonstrating transparency to ensure that students are fully informed about how Northeast’s professional licensure and certification programs align with the educational standards of a state or territory, empowering them to make informed decisions about their education and future career paths.

This attestation must be completed prior to acceptance into the program. If the attestation is not completed, you will not be allowed to enroll in courses.

Please correct the following errors:

I,

acknowledge that I have been informed by Northeast Community College that the program that I intend to enroll is not designed to meet the educational requirements for licensure or certification in

State where you are currently located or plan to be located

I have conferred with the

program director and have received resources and support in order to make this decision.

I attest that I will seek employment in

following completion of the program.

Electronic Record and Signature Disclosure

Northeast is required by law to provide to you certain written notices or disclosures. The terms and conditions for providing to you such notices and disclosures electronically are provided on the Northeast website. Please read the information carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure, please confirm your agreement by selecting the checkbox next to 'I agree to use electronic records and signatures' before typing your electronic signature for this attestation. I understand that my electronic signature has the same legal effect as a handwritten signature.