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Drug, Alcohol, and Substance Abuse Screening Participation Form
Student ID Number
*
Please input your Student ID Number here. Your ID number is 9 characters long in total. Your ID begins with the letter "A" and numeral zero, and is followed by 7 numbers. When you input your full student ID number, it should look like this example: A01234567.
Cadet Name
*
First
Last
Email Address
*
Date of Birth
*
Month
Day
Year
Hidden
Policy and Agreement
Policy and Agreement
I understand that my enrollment as a student at Marion Military Institute and a member of the Marion Military Institute (MMI) Corps of Cadets is contingent upon practicing and participating in a Drug-Free lifestyle. I acknowledge that information pertaining to the Institute’s Drug and Alcohol Awareness Program as well as policies and procedures pertaining to the use, possession or sale of illegal or controlled substances can be referenced in Chapter 11 of the MMI Cadet Manual. I also understand that additional information concerning MMI’s drug and alcohol policies can be referenced through the cadet health center as well as section 3.2 of MMI’s Faculty and Staff Handbook. Additionally, MMI’s policy is in compliance with the Alabama Community College Conference Drug Education and Testing Policy. Commensurate with MMI and ACCC policies and procedures pertaining to the use, possession, or sale of illegal or unauthorized drugs or use of alcohol, I hereby consent to participate in drug/alcohol screening or testing as directed by MMI’s President, Executive Vice President, Vice President for Student Affairs and Commandant of Cadets, or any other designated representative(s) of the Institute. Drug and alcohol screening and testing may include, but is not limited to, breath testing, urinalysis and/or hair follicle samples. I understand that a positive finding results in immediate dismissal from Marion Military Institute’s Corps of Cadets as specified in Chapter 8 of the MMI Cadet Manual and possible loss of any school sponsored scholarships. I also acknowledge that a criminal conviction for any offense, during a period of enrollment for which I receive Title IV, HEA program funds, under any federal or state law involving the possession or sale of illegal drugs will result in the loss of eligibility for any Title IV, HEA grant, loan, or work-study assistance (see HEA sec. 484r (1); (20 U.S.C. 1091r(1).
Policy and Agreement
*
I verify that I have read and agree to the Drug, Alcohol, and Substance Abuse Screening Participation Form/ Notice of Federal/School Student Financial Aid Penalties.
Digital Signature
*
Date of Form Completion
*
MM slash DD slash YYYY
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