DRUG & ALCOHOL SCREENING I agree to submit a drug and alcohol screening prior to my admission into the program. I agree to submit to immediate monitored drug and alcohol testing upon request of a program instructor and/or the Director of the program at any time while a student in the program. I understand that drug and alcohol testing shall be requested whenever there is reasonable suspicion that I am under the influence of drugs and/or alcohol. I also understand that all information regarding drug and alcohol testing and resulting rehabilitation will be kept confidential and will be maintained in a file separate from my regular file in the office of the director of the program.

CRIMINAL BACKGROUND CHECK I agree to submit a criminal background check prior to my admission into the program. I agree to submit to immediate background screening as directed by the Program at any time while a student in the program. I also understand that all criminal background information disclosing a conviction (or pending charge) will be disclosed to the clinical facilities for qualification, further my results will be maintained in a file separate from my regular file in the office of the director of the program.

PERMISSION TO RELEASE
Taft College has my permission to release the results from my drug/alcohol test, background screening, physical examination, TB test and immunizations/titers to the clinical education centers to which I am assigned while a student in the program. I understand that this form will remain in effect for the duration that I am enrolled in a Taft College Allied Health Program.