Background Information
The college requires that all applicants reply to the following questions about their background. Failure to
complete and honestly answer background questions may delay your admission.
1. Have y
ou ever been charged or convicted of any felony, misdemeanor, or crime in any state or
country (including sealed cases, unless expunged)?* Yes No
If y
es, please list original date of offense and convicted charge with date of offense (if different
from original charge):
Have you ever been suspended or expelled, or are you currently facing disciplinary charges at any
educational institution?* Yes No
If yes, ch
eck all that apply:
2.
Suspended Expelled Currently Facing Charge
Please give a complete explanation and list dates. Attach a separate page if needed.
Notice to Applicants with Criminal Records
Applicants with felony, misdemeanor or criminal convictions may not be accepted to academic programs
that require an internship or clinical hours. Moreover, applicants to certain programs are required to
submit a criminal background check. SMC does not in any way guarantee that students with prior criminal
convictions will be able to 1) complete their academic program, 2) attain health occupations licensure in
the state of Michigan or 3) be able to secure employment upon completion of a program.
Equal Opportunity Policy
Southwestern Michigan College is committed to a policy of equal opportunity for students, faculty and
staff. The college complies with all federal laws and regulations prohibiting discrimination including Title
VI, Title IX, Section 504, and Title II of the Americans with Disabilities Act and with all requirements and
regulations of the U.S. Department of Education. The college’s occupational educational opportunities will
be offered without regard to race, color, national origin, sex or disability.
Inquiries regarding this policy and/or application of Title VI, Title IX, Section 504 or the ADA may be
referred to Brent Brewer, Chief of Staff, David C. Briegel Building, room 2104, 58900 Cherry Grove Road,
Dowagiac, MI, 49047, 269-782-1276.
Read Before Signing: By signing, I certify that all of the answers given in this application are complete
and accurate to the best of my knowledge. If I have provided any false information or omitted any
information or provided only partial information, I understand that I may not be admitted to the college. If
false information is discovered after I am enrolled, I may be immediately expelled from the college and
my nonimmigrant status will be terminated. I certify that I have reviewed and will abide by the Student
Code of Conduct, and I understand that my nonimmigrant status is contingent on my academic
performance and my adherence to the Student Code of Conduct.
Signature: _ ____________________________________________ Date: ________________
Revised 9/10/19 3
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