I authorize the contacts, schools, organizations, institutions, and employers named in this application to provide Philadelphia OIC with all relevant information that may be requested in regard to my past employment, education and other activities. I certify that the information and statements contained in my application are true and correct to the best of my knowledge. I understand that any misrepresentation or omission of a material fact may result in me being denied admission or immediate termination (after admission into Philadelphia OIC). Furthermore, if I am admitted, I understand that my admission is for no definite term and that I can be terminated at any time and for any reason, notwithstanding any of the information contained in the Philadelphia OIC's Student Handbook or any other document provided to me during my participation with Philadelphia OIC programs and activities. I agree to hold harmless Philadelphia OIC staff, board of directors, vendors, contractors, volunteers and anyone else affiliated with Philadelphia OIC in any way.
Yes, I understand that the submission of this form is in acknowledgment of the authorization of release of my information as set forth by Philadelphia OIC and its employment and educational partners.