As a student in the Early Childhood/Elementary Education program at HACC, I acknowledge that I have

read and understand these program standards. I acknowledge that I am capable of pedorming the
abilities and skills outlined in this document with or without reasonable accommodations and
understand that my status as a student in this program depends on my continued ability to successfully
demonstrate these abilities and skills. I understand that if I a;11;rp-longer able to rneet these program
standards, t will immediately notify the program director. #-(initial)

I understand that all students accepted in the Early ChildhoodlElementary Education program must
undergo an annual PA Child Abuse History Clearance, PA State Police Criminal Record Check, and
FBI Fingerprint Gheck at the student's expense. No studenlwill be admitted or retained in the program
with a disqualifying criminal history or child abuse clearance. {< (initial)

I understand that altstudents accepted in the eaity Childhood/Elementary Education programs must
have an annual TB screening at the studgnt's expense. No student will be admitted or retained in the
program with a disqualifying TB test. r
)k((initiat)
I understand that all students accepted in the Early Childhood/Elementary Education program will review,
sign, and follow the NAEYC Code of E$ical Conduct "Statement of Commitment" during his or her
participation in EDUC 110 or 111. ZzZ (initial)

I understand that all students accepted in the Early Childhood/Elementary Education program will participate
in Mandated ReporterTraining during EDUC 110 or 111. Students must provide proof of training completion
nV an officialcertifriate upln completion. @$nitiat\
"rOmitting
I understand that all students accepted in the Early Childhood/Elementary Education program must sign and
adhere to the HACC Cell Phone policy completed during EDUC 110 of)tj Failure to comply during class
and/or Field Experiences may result in removalfrom the program. K (initial)

To be signed while enrolled in EDUC 110 or {{{:

Appricant sisnature / / oate:N- 16' fi

EDUC110/111 rnstru.tJrsisn"tri" (o* {- -&*r-. - D"t", /-,//6 //7