Admission Application

Personal Info I
I would like to enroll in the class that begins
Name*
Address*
City*
State*
Province*
State / Province
Zip Code
Country*
Phone
Cell
Email*

Personal Info II
Date of Birth*
MM
DD
YYYY
Place of Birth*
Nationality*
SSN*
Social Security Number required if U.S. Citizen.
Your SSN is transmitted and stored securely.
Sex*
- Male
- Female
Marital Status*
Ethnicity

Military Experience
U.S. Military Branch Served*
Dates of Service - Start
MM
DD
YYYY
End
MM
DD
YYYY
Highest Rank
Training Received
Have you ever been in the reserves?
- Yes
- No
Have you ever used your education benefits before?
- Yes
- No

Dive Experience
(NO PRIOR EXPERIENCE NECESSARY)
SCUBA Qualified*
- Yes
- No
Depth*
Certified By:*
Mixed Gas*
- Yes
- No
Depth*
Certified By:*
Hard Hat*
- Yes
- No
Depth*
Certified By:*

Qualifications
List any special skills or trades you have:
Skill 1
Length of experience: (1)
Skill 2
Length of experience: (2)
Skill 3
Length of experience: (3)

References
Divers Institute of Technology requires applicants to provide one reference. Please list your reference below
Name
Phone #
Cell #
Relationship
Name
What lead you to apply to DIT?
This is an optional survey question.

Physical Requirements
Diving requires you to be in top physical condition. The effects of cold water, pressure, waves, currents, etc., are a constant strain on the body. A thorough physical examination is necessary prior to being exposed to hyperbaric conditions and beginning your dive training. The exam must be completed using the forms provided by Divers Institute of Technology. Ask your Admissions Representative to provide these if you do not already have them. The physical is not a requirement for application and acceptance, but must be completed at the beginning of training.

Signature
For the protection of all parties, it is agreed that no agreements or promises were made to me other than those set forth in this application and the school catalog, which I acknowledge having received. In consideration of the fact that I may be, from time to time, involved in publicity photographs and name releases, and a copy being made to me on request, I consent and agree that the school and its agents and successors in interest may use and reproduce my name and photograph for any and all purposes in any media. I understand that this is not a contract. I further understand that all other application forms, including an enrollment agreement (contract) will be processed after acceptance of this application for admission by the school. Acceptance of this application is at the sole discretion of the school.

I further state that all of the information provided is true to the best of my knowledge.
Signature*
Date*
MM
DD
YYYY

Transcript Request Form
Do You Want To Create a Transcript Request Form Authorizing DIT To Receive Your Records?
- Yes
- No
I authorize an official or unofficial copy of my high school transcripts, diploma, or GED to be faxed, emailed, or mailed to the registrar at Divers Institute of Technology.
By Checking the box and filling in your name you are creating an E-Signature.*
- I Agree
Signature*

Attendance Policy
Because continuity is essential to a student’s academic progress and future job performance, DIT requires students to maintain 90% or better attendance throughout the 900-hour program. Every absence, including partial day absences due to tardiness or for other reasons, will be recorded as an absence for the actual period of time involved. Students with less than satisfactory attendance are at risk for probation or termination. Unexcused absences in any subject week may result in a failed grade for that week. Missed time will be made up after graduation at a cost of $250.00 per day and a passing grade must be achieved in order to receive certifications, if applicable.

Students missing more than 10% of the scheduled hours, at any point in the program, will be placed on probation for a minimum of 30 days.

The student will be ineligible to receive additional financial aid until the hours in excess of 10% of the scheduled hours are made up. A student can only be placed on probation for attendance two times. If a third violation occurs, he/she will be terminated from enrollment.

It is critical to maintain good attendance during the first four (4) weeks of the program. Any absences during those first four (4) weeks could delay funding and affect grades to a point where students may fail.

By signing below, I acknowledge and understand that I have read the attendance policy. I further acknowledge that I have no known appointments, court dates, etc. that conflict with my class schedule.
By Checking the box and filling in your name you are creating an E-Signature.*
- I Agree
Signature*
Date*
MM
DD
YYYY

Student Drug & Alcohol Policy
Purpose of Policy and Expectations Regarding Drug and Alcohol Use

Safety is our primary concern at DIT and to that end we strictly prohibit students from using illicit drugs while participating in the program. Furthermore, we prohibit students from being under the influence of alcohol or marijuana (including medical marijuana) while at school or while participating in school-related activities. The purpose of this policy is to clearly communicate these expectations to students as well as to outline our testing policies, which you will be subject to as a student at DIT.

Students are prohibited from consuming, possessing, or being under the influence of alcohol while on campus during school hours, and while participating in school-related activities. Prohibited alcohol use includes:
- Having a breath alcohol concentration of .02 percent or greater as indicated by an alcohol breath test or urinalysis;
- Using alcohol within four (4) hours of any planned student activity;
- Being under the influence of alcohol, or the lasting effects of a hangover, such that the student may not safely participate in a planned student activity, as apparent by observation.
Students are prohibited from consuming or being under the influence of illicit drugs while enrolled in the program, and from possessing or distributing illicit drugs while on campus, including, but not limited to, marijuana and medical marijuana. Although the state of Washington has legalized the personal use of marijuana, it is still a Schedule I Hallucinogenic substance under the Washington Uniform Controlled Substances Act (RCW § 69.50.204) and illegal under federal law. “Since marijuana is illegal under federal law institutions that receive federal funds will still be subject to mandated testing” (WA State Liquor and Control Board: http://www.liq.wa.gov/mj2015/faqs_i-502).

Students are to report to their instructor ANY current prescription or over-the-counter medications that may impair his/her ability to participate safely in any classroom activity, including but not limited to diving activity, prior to participating in such activity.

All students are subject to drug and alcohol testing while enrolled at DIT. Any student testing positive as defined by this policy will be suspended with a recommendation for termination from the program. Any refusal to test will be considered a violation of policy and will also be grounds for suspension with a recommendation for termination from the program. Any alteration of a test will also be considered a violation of policy and will be grounds for suspension with a recommendation for termination from the program.

By signing this policy, I acknowledge and understand the expectations of DIT and the consequences of a failed test. I further consent to testing as required under this policy.
By Checking the box and filling in your name you are creating an E-Signature.*
- I Agree
Signature*
Date*
MM
DD
YYYY

Divers Institute of Technology

Application Progress

Personal Info I

Personal Info II

Education

High School

GENERAL EDUCATIONAL DEVELOPMENT (G.E.D.):

POST SECONDARY EDUCATION (COLLEGE OR CERTIFICATE PROGRAMS):

Military Experience

Dive Experience

Qualifications

References

Physical Requirements

Medical Interview

Signature

Transcript Request Form

Attendance Policy

Student Drug & Alcohol Policy

Purpose of Policy and Expectations Regarding Drug and Alcohol Use