MDHSA Diploma Program Registration Form

FAMILIES MUST PURCHASE AN MDHSA DIPLOMA GUIDE BEFORE REGISTERING WITH THE PROGRAM!

Complete the form below and remit the $40 one-time (non-refundable) Diploma Program Registration Fee to become enrolled in the MDHSA Diploma Program.

Once your payment and registration form have been received and processed by the MDHSA office, you will be sent an email with instructions on how to log in to the secured Diploma Program Participants section of the MDHSA website. Please save this email! If you do not receive the email within 5 business days of registering, please check your spam or junk folders before contacting the MDHSA office.

Following the completion of the online registration and payment, you will be directed to an instruction page with information on mailing yearly paperwork. Please retain the information so your student’s file is properly credited for the payment and kept up-to-date!

Thank you for registering with the MDHSA Diploma Program!

REQUIRED: YOU MUST READ THE FOLLOWING STATEMENTS AND ACKNOWLEDGE BELOW THAT YOU ACCEPT THEM. We have read the MDHSA Diploma Program Guide and the ADVISEMENT and we understand our responsibilities and privileges in this Program. We also certify that all the information on each Annual Summary Form and Transcript will be / is true and accurate. THE MDHSA TRANSCRIPT IS A LEGAL DOCUMENT AND COPYRIGHT PROTECTED. We will use the MDHSA name and the Transcript form only on or for an MDHSA Transcript. We will not print a draft that has not been seen or approved or signed by the MDHSA office and pass it on to any person, college, employer, or other institution, as official. By typing our names below, we are digitally signing this electronic Diploma Program Registration Form and are agreeing to these statements. Failure to agree and adhere to the terms of the Diploma Program will result in a forfeiture of the Registration Fees and non-admittance in the MDHSA Diploma Program.
--- DOB and SSN are used for Transcripts for colleges, and may be omitted if there is an objection to providing this information. If not provided at the time of Registration, the information may be sent to MDHSA at a later date, if needed. ---