Attestation Form

    Attestation Form

    The program you have applied to or are interested in pursuing leads to a professional license or certification that is required for employment. Professional licensure/certification requirements vary from state to state, which may affect a student’s ability to apply for a professional license/certification upon the completion of the program. The U.S. Department of Education requires institutions to disclose educational requirements for programs leading to professional licensure or certification.

    Parkland College has determined that your intended program of study does not meet the professional licensure requirements in the current state you reside in, based on your permanent residence.

    Federal regulation, § 668.14 requires students to complete the Attestation Form prior to enrollment at Parkland College into a professional licensure or state certification program that does not meet the educational requirements for the state or territory where the student is located. The Attestation Form serves as a crucial tool to ensure that students engage in the decision-making process with full awareness and consent. Once the form has been received, it will be considered on a case-by-case basis if enrollment will be allowed.

    Student Declarations
    Student Information
    Birthdate
    Birthdate
    Program of Study